Provider Demographics
NPI:1740554385
Name:ROBERTS, MARILYN RUTH (LCSW-BACS)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:RUTH
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LCSW-BACS
Other - Prefix:MS
Other - First Name:MARILYN
Other - Middle Name:R
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-BACS
Mailing Address - Street 1:4422 GENERAL MEYER AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-3588
Mailing Address - Country:US
Mailing Address - Phone:504-361-6092
Mailing Address - Fax:504-361-6256
Practice Address - Street 1:4422 GENERAL MEYER AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-3588
Practice Address - Country:US
Practice Address - Phone:504-361-6092
Practice Address - Fax:504-361-6256
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA34231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical