Provider Demographics
NPI:1750672069
Name:ROBERTS, BARBARA (LCSW)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:BERDINKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 KNOLLWOOD DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:CANTERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06331-1470
Mailing Address - Country:US
Mailing Address - Phone:860-546-9511
Mailing Address - Fax:
Practice Address - Street 1:1 KNOLLWOOD DR
Practice Address - Street 2:SUITE 6
Practice Address - City:CANTERBURY
Practice Address - State:CT
Practice Address - Zip Code:06331-1470
Practice Address - Country:US
Practice Address - Phone:860-546-9511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0074671041C0700X
NY0775181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008031064Medicaid
CT008031064Medicaid