Provider Demographics
NPI:1053339929
Name:SEVERO, ROBERTA E (LCSW LSATP)
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:E
Last Name:SEVERO
Suffix:
Gender:F
Credentials:LCSW LSATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3912 PINELAND ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3321
Mailing Address - Country:US
Mailing Address - Phone:703-978-1885
Mailing Address - Fax:
Practice Address - Street 1:3912 PINELAND ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3321
Practice Address - Country:US
Practice Address - Phone:703-978-1885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0718000078101YA0400X
VA09040024051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical