Provider Demographics
NPI:1942828454
Name:SCHUMACHER, ROBERTA COOK (BA SOCIAL WORKER)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:COOK
Last Name:SCHUMACHER
Suffix:
Gender:F
Credentials:BA SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 TAYLOR SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-7495
Mailing Address - Country:US
Mailing Address - Phone:304-695-0981
Mailing Address - Fax:
Practice Address - Street 1:804 TAYLOR SCHOOL RD
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-7495
Practice Address - Country:US
Practice Address - Phone:304-695-0981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAP00940832171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
3737OtherSOCIAL WORKER
WA3737Medicaid
WV6950981Medicaid