Provider Demographics
NPI:1245383512
Name:ROBERTS, GENEVA R (PHD LCSWC LICSW)
Entity Type:Individual
Prefix:
First Name:GENEVA
Middle Name:R
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PHD LCSWC LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 AVENTURA COURT
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133
Mailing Address - Country:US
Mailing Address - Phone:410-922-4475
Mailing Address - Fax:
Practice Address - Street 1:659 A MAIN STREET
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707
Practice Address - Country:US
Practice Address - Phone:301-490-0550
Practice Address - Fax:301-490-9758
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD105121041C0700X
DCLC3017071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical