Provider Demographics
NPI:1922458447
Name:ROBERTS, LINDA L (LCSW, CEAP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LCSW, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 COOPER AVE
Mailing Address - Street 2:SUITE 5D
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1883
Mailing Address - Country:US
Mailing Address - Phone:973-261-8645
Mailing Address - Fax:
Practice Address - Street 1:209 COOPER AVE
Practice Address - Street 2:SUITE 5D
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1883
Practice Address - Country:US
Practice Address - Phone:973-261-8645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054866001041C0700X
NY89758351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical