Provider Demographics
NPI:1669827705
Name:ROBERTS, ELIZABETH
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 BRITTANY DR
Mailing Address - Street 2:STE. A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-9128
Mailing Address - Country:US
Mailing Address - Phone:225-767-3372
Mailing Address - Fax:225-767-8255
Practice Address - Street 1:5425 BRITTANY DR
Practice Address - Street 2:STE. A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-9128
Practice Address - Country:US
Practice Address - Phone:225-767-3372
Practice Address - Fax:225-767-8255
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA90701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical