Provider Demographics
NPI:1073503397
Name:ROBERTS, SANDRA E (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:E
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BOULDERS PKWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225
Mailing Address - Country:US
Mailing Address - Phone:804-320-7881
Mailing Address - Fax:804-560-3474
Practice Address - Street 1:1000 BOULDERS PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225
Practice Address - Country:US
Practice Address - Phone:804-320-7881
Practice Address - Fax:804-560-3474
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA07100001831041C0700X
VA09040018741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008906459Medicaid
VA800001034Medicare PIN