Provider Demographics
NPI:1417017518
Name:THOMAS, ROBERTA CHRISTINE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:CHRISTINE
Last Name:THOMAS
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 1:625 GATEWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356
Mailing Address - Country:US
Mailing Address - Phone:219-736-0230
Mailing Address - Fax:219-696-8569
Practice Address - Street 1:416 EAST 86TH AVENUE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410
Practice Address - Country:US
Practice Address - Phone:219-736-0230
Practice Address - Fax:219-696-8569
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2010-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002343A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
404570Medicare ID - Type Unspecified
404570Medicare UPIN