Provider Demographics
NPI:1356688774
Name:SMITH, ROBERTA MARIE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 CARY ST
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-2706
Mailing Address - Country:US
Mailing Address - Phone:815-669-9590
Mailing Address - Fax:847-462-8718
Practice Address - Street 1:114 CARY ST
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-2706
Practice Address - Country:US
Practice Address - Phone:815-669-9590
Practice Address - Fax:847-462-8718
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0169561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical