Provider Demographics
NPI:1093986440
Name:STAIGERS, ROBERTA GRAY (MSSW, LISW)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:GRAY
Last Name:STAIGERS
Suffix:
Gender:F
Credentials:MSSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 W RIVERVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-6424
Mailing Address - Country:US
Mailing Address - Phone:937-296-1007
Mailing Address - Fax:
Practice Address - Street 1:922 W RIVERVIEW AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-6424
Practice Address - Country:US
Practice Address - Phone:937-296-1007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0002143101Y00000X, 101YM0800X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000284606OtherANTHEM
OH291993OtherMANAGED HEALTH NETWORK
OH62-20934OtherUNITED BEHAVIORAL HEALTH
OHSW10713Medicare PIN