Provider Demographics
NPI:1447744651
Name:ROBERTS, LAUREN MARIE (LISW)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:MARIE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 DORSH RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3837
Mailing Address - Country:US
Mailing Address - Phone:734-546-2156
Mailing Address - Fax:216-823-0544
Practice Address - Street 1:1323 DORSH RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-3837
Practice Address - Country:US
Practice Address - Phone:734-546-2156
Practice Address - Fax:216-823-0544
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.2203593104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker