Provider Demographics
NPI:1932695061
Name:ROBERTO, TERRY L (LCSW)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:ROBERTO
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 1:7148 DAMITA DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-4912
Mailing Address - Country:US
Mailing Address - Phone:561-870-8041
Mailing Address - Fax:
Practice Address - Street 1:7148 DAMITA DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-4912
Practice Address - Country:US
Practice Address - Phone:561-870-8041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-01
Last Update Date:2018-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW151491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical