Provider Demographics
NPI:1104535533
Name:ROBERTS, SUSAN (LCSW MO)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LCSW MO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BRIDGESCOMMUNITYSERVICES.COM
Mailing Address - Street 2:41197 GOLDEN GATE CIR, STE 104 MURRIETA, CA 92562
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562
Mailing Address - Country:US
Mailing Address - Phone:515-444-8642
Mailing Address - Fax:
Practice Address - Street 1:6865 W 51ST TER APT 2B
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-1577
Practice Address - Country:US
Practice Address - Phone:913-202-0234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020043029104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker