Provider Demographics
NPI:1649862517
Name:ROBERTS, JEFFREY EUGENE (LCSW)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:EUGENE
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2291 STATE ROUTE 28A
Mailing Address - Street 2:
Mailing Address - City:OLIVEBRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12461-5709
Mailing Address - Country:US
Mailing Address - Phone:845-418-2118
Mailing Address - Fax:
Practice Address - Street 1:2291 STATE ROUTE 28A
Practice Address - Street 2:
Practice Address - City:OLIVEBRIDGE
Practice Address - State:NY
Practice Address - Zip Code:12461-5709
Practice Address - Country:US
Practice Address - Phone:845-418-2118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0907691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical