Provider Demographics
NPI:1215177811
Name:ROBERTS, DOXENE L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DOXENE
Middle Name:L
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 1:440 E SANDFORD BLVD # 3492
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-4752
Mailing Address - Country:US
Mailing Address - Phone:914-712-8837
Mailing Address - Fax:
Practice Address - Street 1:440 E SANDFORD BLVD # 3492
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-4752
Practice Address - Country:US
Practice Address - Phone:914-712-8837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO531251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical