Provider Demographics
NPI:1194891994
Name:ROBERTS, STEPHEN H (LCSW, CSAC)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:H
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:LCSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CAMELOT DRIVE
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935
Mailing Address - Country:US
Mailing Address - Phone:920-907-8201
Mailing Address - Fax:920-907-8209
Practice Address - Street 1:40 CAMELOT DRIVE
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935
Practice Address - Country:US
Practice Address - Phone:920-907-8201
Practice Address - Fax:920-907-8209
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI672101YA0400X
WI31051041C0700X
WI3105-1231041C0700X
WI672-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39307400Medicaid
WI39307400Medicaid