Provider Demographics
NPI:1902215692
Name:ROBERTS, EMILY RUTH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:RUTH
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2894 S NIBLEY PARK PL
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-4391
Mailing Address - Country:US
Mailing Address - Phone:801-232-3723
Mailing Address - Fax:
Practice Address - Street 1:5689 S REDWOOD RD UNIT 28B
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-5499
Practice Address - Country:US
Practice Address - Phone:801-232-3723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5528406-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical