Provider Demographics
NPI:1821217449
Name:ROBERTS, STEPHEN JOSEPH
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JOSEPH
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7018 STEWART CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-2261
Mailing Address - Country:US
Mailing Address - Phone:317-578-4144
Mailing Address - Fax:
Practice Address - Street 1:9292 N MERIDIAN ST
Practice Address - Street 2:SUITE 311
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1857
Practice Address - Country:US
Practice Address - Phone:317-843-0710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001490A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical