Provider Demographics
NPI:1376980854
Name:ERWIN, ROBERTA CAROL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:CAROL
Last Name:ERWIN
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 1:575 E 100 S
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-3102
Mailing Address - Country:US
Mailing Address - Phone:435-637-2358
Mailing Address - Fax:
Practice Address - Street 1:145 E 1300 S
Practice Address - Street 2:SUITE #501
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-5482
Practice Address - Country:US
Practice Address - Phone:385-468-3523
Practice Address - Fax:385-468-3560
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7987936-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical