Provider Demographics
NPI:1225192594
Name:ROBERTS-BIRD DBA LIBERTY COUNSELING, LILA L (MSW)
Entity Type:Individual
Prefix:
First Name:LILA
Middle Name:L
Last Name:ROBERTS-BIRD DBA LIBERTY COUNSELING
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 W HURON ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:54923-1545
Mailing Address - Country:US
Mailing Address - Phone:920-210-7181
Mailing Address - Fax:920-361-2334
Practice Address - Street 1:315 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WAUPUN
Practice Address - State:WI
Practice Address - Zip Code:53963-2032
Practice Address - Country:US
Practice Address - Phone:920-210-7181
Practice Address - Fax:920-324-5700
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1827-1231041C0700X
WI448-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39637200Medicaid
WI084611007Medicare ID - Type Unspecified
WI39637200Medicaid