Provider Demographics
NPI:1639619026
Name:ROBERTS, KARLEE (LMSW)
Entity Type:Individual
Prefix:
First Name:KARLEE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 N MAIN ST
Mailing Address - Street 2:JOHN D KELLY BEHAVIORAL HEALTH
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-1070
Mailing Address - Country:US
Mailing Address - Phone:315-531-2400
Mailing Address - Fax:315-531-2436
Practice Address - Street 1:418 N MAIN ST
Practice Address - Street 2:JOHN D KELLY BEHAVIORAL HEALTH
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1070
Practice Address - Country:US
Practice Address - Phone:315-531-2400
Practice Address - Fax:315-531-2436
Is Sole Proprietor?:No
Enumeration Date:2017-03-03
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098724-1104100000X
IL149.0208141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker