Provider Demographics
NPI:1720011646
Name:ROBERTS, HAYWARD B (LMSW)
Entity Type:Individual
Prefix:MR
First Name:HAYWARD
Middle Name:B
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2833 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-5734
Mailing Address - Country:US
Mailing Address - Phone:850-471-7608
Mailing Address - Fax:850-471-7744
Practice Address - Street 1:312 KENMORE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-7462
Practice Address - Country:US
Practice Address - Phone:850-471-7608
Practice Address - Fax:850-471-7744
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7140104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker