Provider Demographics
NPI:1154432664
Name:LINDAU, ROBERTA (LCSW)
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:
Last Name:LINDAU
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5099
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-5099
Mailing Address - Country:US
Mailing Address - Phone:912-882-3662
Mailing Address - Fax:
Practice Address - Street 1:10545 COLERAIN RD
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-3720
Practice Address - Country:US
Practice Address - Phone:912-882-3662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0008851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10753192OtherCAQH
GA10753192OtherCAQH
GA80BBBFNMedicare ID - Type Unspecified