Provider Demographics
NPI:1922168665
Name:ROBERTS, CHRISTINE KENNY (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:KENNY
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BEAVERBANK CIR
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-3311
Mailing Address - Country:US
Mailing Address - Phone:410-615-3345
Mailing Address - Fax:
Practice Address - Street 1:1407 YORK RD
Practice Address - Street 2:SUITE 307
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6097
Practice Address - Country:US
Practice Address - Phone:410-615-3345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05051101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health