Provider Demographics
NPI:1346641610
Name:AMELIA ROBERTS, MSW, LISW
Entity Type:Organization
Organization Name:AMELIA ROBERTS, MSW, LISW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LISW
Authorized Official - Phone:740-804-9529
Mailing Address - Street 1:5421 RYEBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-8209
Mailing Address - Country:US
Mailing Address - Phone:740-804-9529
Mailing Address - Fax:
Practice Address - Street 1:3600 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1475
Practice Address - Country:US
Practice Address - Phone:740-625-1574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14503971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty