Provider Demographics
NPI:1184720492
Name:ROBERTS, JUDITH VIRGINIA (MSW LMHP CSW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:VIRGINIA
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MSW LMHP CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5098 S HAYTHORN RD
Mailing Address - Street 2:
Mailing Address - City:MAXWELL
Mailing Address - State:NE
Mailing Address - Zip Code:69151-1007
Mailing Address - Country:US
Mailing Address - Phone:308-582-4478
Mailing Address - Fax:
Practice Address - Street 1:5098 S HAYTHORN RD
Practice Address - Street 2:
Practice Address - City:MAXWELL
Practice Address - State:NE
Practice Address - Zip Code:69151-1007
Practice Address - Country:US
Practice Address - Phone:308-582-4478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2261101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health