Provider Demographics
NPI:1043837388
Name:TAYLOR, ROBERTA OLIVIA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:OLIVIA
Last Name:TAYLOR
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 1:1065 DOLSONTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-4744
Mailing Address - Country:US
Mailing Address - Phone:718-869-4652
Mailing Address - Fax:
Practice Address - Street 1:1065 DOLSONTOWN RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-4744
Practice Address - Country:US
Practice Address - Phone:718-869-4652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NY078785104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker