Provider Demographics
NPI:1730431586
Name:ROBERTS, DANIEL (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-2619
Mailing Address - Country:US
Mailing Address - Phone:850-296-7807
Mailing Address - Fax:
Practice Address - Street 1:730 E PARK AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-2619
Practice Address - Country:US
Practice Address - Phone:850-296-7807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW 65411041C0700X
FLSW 121731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical