Provider Demographics
NPI:1881022135
Name:ROBERTS, BRENDA JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JEAN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:JEAN
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5664 SW 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-5677
Mailing Address - Country:US
Mailing Address - Phone:352-291-5485
Mailing Address - Fax:352-291-9536
Practice Address - Street 1:3238 S LECANTO HWY
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-9025
Practice Address - Country:US
Practice Address - Phone:352-628-5020
Practice Address - Fax:352-628-2016
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-24
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW116591041C0700X
FLISW68031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical