Provider Demographics
NPI:1891561668
Name:ROBERTS, ALICE FISHER (PHD, LCSW, CST)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:FISHER
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PHD, LCSW, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 N 100 E
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-1876
Mailing Address - Country:US
Mailing Address - Phone:801-296-2425
Mailing Address - Fax:
Practice Address - Street 1:25 S MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-1846
Practice Address - Country:US
Practice Address - Phone:801-872-8862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-01
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID410521041C0700X
UT10496970-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical