Provider Demographics
NPI:1740718246
Name:ROBERTS, STEPHANIE L (LISW-CP)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:L
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 KILLARNEY LN
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-7050
Mailing Address - Country:US
Mailing Address - Phone:803-468-5808
Mailing Address - Fax:
Practice Address - Street 1:528 BROAD ST STE 101
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-3368
Practice Address - Country:US
Practice Address - Phone:803-720-9151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-27
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker