Provider Demographics
NPI:1558586545
Name:TAFFER, ROBERTA C (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:C
Last Name:TAFFER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:C
Other - Last Name:GOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:705 SUMMERFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ASBURY PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-6921
Mailing Address - Country:US
Mailing Address - Phone:732-774-6886
Mailing Address - Fax:732-774-8809
Practice Address - Street 1:705 SUMMERFIELD AVE
Practice Address - Street 2:
Practice Address - City:ASBURY PARK
Practice Address - State:NJ
Practice Address - Zip Code:07712-6921
Practice Address - Country:US
Practice Address - Phone:732-774-6886
Practice Address - Fax:732-774-8809
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC004033001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ187298Medicare ID - Type Unspecified