Provider Demographics
NPI:1083405633
Name:SHORTER, ROBERT J (LCSW)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:SHORTER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 GRANDIN RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-2815
Mailing Address - Country:US
Mailing Address - Phone:540-988-3108
Mailing Address - Fax:855-515-5360
Practice Address - Street 1:1719 GRANDIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24015-2815
Practice Address - Country:US
Practice Address - Phone:540-988-3108
Practice Address - Fax:855-515-5360
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040184181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty