Provider Demographics
NPI:1467526590
Name:ROBERTS, CATHERINE M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:M
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CATHERINE
Other - Middle Name:M
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:101 PARK ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2963
Mailing Address - Country:US
Mailing Address - Phone:973-783-0495
Mailing Address - Fax:
Practice Address - Street 1:101 PARK ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2963
Practice Address - Country:US
Practice Address - Phone:973-783-0495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2013-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC043779001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJR0740778Medicare ID - Type Unspecified