Provider Demographics
NPI:1265024269
Name:KANTOWSKI, ROBERTA HAMM (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:HAMM
Last Name:KANTOWSKI
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 1:3112 NW DENVER AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-3864
Mailing Address - Country:US
Mailing Address - Phone:580-695-5929
Mailing Address - Fax:
Practice Address - Street 1:3112 NW DENVER AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-3864
Practice Address - Country:US
Practice Address - Phone:580-695-5929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3881104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker