Provider Demographics
NPI:1053859231
Name:ROBERTS, AMELIA (MSW, LISW-S)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W 5TH AVE
Mailing Address - Street 2:102C
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-2503
Mailing Address - Country:US
Mailing Address - Phone:614-398-1927
Mailing Address - Fax:614-824-4271
Practice Address - Street 1:1200 W 5TH AVE
Practice Address - Street 2:102C
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-2503
Practice Address - Country:US
Practice Address - Phone:614-398-1927
Practice Address - Fax:614-824-4271
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14503971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical