Provider Demographics
NPI:1356610224
Name:ROBERTS, PAMELA SUE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:SUE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 JEFFERSON LANDING CIR
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1989
Mailing Address - Country:US
Mailing Address - Phone:631-474-3285
Mailing Address - Fax:
Practice Address - Street 1:134 MAIN ST
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2833
Practice Address - Country:US
Practice Address - Phone:631-730-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0525861041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool