Provider Demographics
NPI:1205641297
Name:ROBERTS, RUBY ELIZABETH (LICSW)
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:ELIZABETH
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9566 NE SHIPPING LN
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:WA
Mailing Address - Zip Code:98346-8701
Mailing Address - Country:US
Mailing Address - Phone:360-620-5314
Mailing Address - Fax:
Practice Address - Street 1:9566 NE SHIPPING LN
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:WA
Practice Address - Zip Code:98346-8701
Practice Address - Country:US
Practice Address - Phone:360-620-5314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-08
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical