Provider Demographics
NPI:1043415573
Name:ROBERTS, MARILYN J (LMSW)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:J
Last Name:ROBERTS
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 E 53RD ST N
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67219-2611
Mailing Address - Country:US
Mailing Address - Phone:316-677-6746
Mailing Address - Fax:
Practice Address - Street 1:915 E 53RD ST N
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:KS
Practice Address - Zip Code:67219-2611
Practice Address - Country:US
Practice Address - Phone:316-677-6746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6657104100000X
KS6910104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1013090489Medicaid