Provider Demographics
NPI:1750048021
Name:ROBERTS, EVYAN (LMSW, LGSW)
Entity Type:Individual
Prefix:MISS
First Name:EVYAN
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LMSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 STIRLING RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-2139
Mailing Address - Country:US
Mailing Address - Phone:301-442-2685
Mailing Address - Fax:
Practice Address - Street 1:1221 LOCUST ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5572
Practice Address - Country:US
Practice Address - Phone:202-503-4373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG200002691041C0700X
MD279481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical