Provider Demographics
NPI:1629193479
Name:ROBERTS, STEPHANIE (LICSW, MA)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LICSW, MA
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:ROSENSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW,MA
Mailing Address - Street 1:208 FLYNN AVE
Mailing Address - Street 2:SUITE 3J
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1138 PINE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5353
Practice Address - Country:US
Practice Address - Phone:802-488-6600
Practice Address - Fax:802-488-6919
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00010141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010681Medicaid