Provider Demographics
NPI:1821607623
Name:ROBERTS, ARIEL (LLMSW)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 S MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2627
Mailing Address - Country:US
Mailing Address - Phone:248-692-4013
Mailing Address - Fax:
Practice Address - Street 1:123 S MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2627
Practice Address - Country:US
Practice Address - Phone:248-692-4013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011076181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical