Provider Demographics
NPI:1518999002
Name:ROBERTS, CARRIE M (LCSW LMHP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:M
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LCSW LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 WEST THIRD
Mailing Address - Street 2:PO BOX 818
Mailing Address - City:MCCOOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001
Mailing Address - Country:US
Mailing Address - Phone:308-345-2770
Mailing Address - Fax:308-345-2557
Practice Address - Street 1:1012 WEST THIRD
Practice Address - Street 2:
Practice Address - City:MCCOOK
Practice Address - State:NE
Practice Address - Zip Code:69001
Practice Address - Country:US
Practice Address - Phone:308-345-2770
Practice Address - Fax:308-345-2557
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE970104100000X
NE2129106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
85042OtherBCBS
240828OtherMIDLANDS CHOICE
85042OtherBCBS