Provider Demographics
NPI:1790947919
Name:ROBERTS, CHRISTINE (LASW)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 42534
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89116-0534
Mailing Address - Country:US
Mailing Address - Phone:702-382-3905
Mailing Address - Fax:702-452-0921
Practice Address - Street 1:4045 E. OGDEN AVENUE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-5359
Practice Address - Country:US
Practice Address - Phone:702-382-3905
Practice Address - Fax:702-798-9910
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-29
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01464-A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker