Provider Demographics
NPI:1043926215
Name:ROBERTS, CATHERINE MICHELLE (LCSW, CCM)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MICHELLE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LCSW, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-4457
Mailing Address - Country:US
Mailing Address - Phone:505-608-1980
Mailing Address - Fax:
Practice Address - Street 1:2616 E 22ND ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-4457
Practice Address - Country:US
Practice Address - Phone:505-608-1980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2023-00021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical