Provider Demographics
NPI:1306217633
Name:ROBERTO, PHILLIP ADAM (MSW, LISW)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:ADAM
Last Name:ROBERTO
Suffix:
Gender:M
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 AIRPORT RD STE 205
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45226-1622
Mailing Address - Country:US
Mailing Address - Phone:513-289-8151
Mailing Address - Fax:
Practice Address - Street 1:4240 AIRPORT RD STE 205
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45226-1622
Practice Address - Country:US
Practice Address - Phone:513-289-8151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.17006491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical