Provider Demographics
NPI:1902334675
Name:ROBERTS, KATELYN ELIZABETH (MSW, LCSWA)
Entity type:Individual
Prefix:MS
First Name:KATELYN
Middle Name:ELIZABETH
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 MCKINLEY AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-1550
Mailing Address - Country:US
Mailing Address - Phone:724-689-2341
Mailing Address - Fax:
Practice Address - Street 1:2124 MCKINLEY AVE APT 1
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-1550
Practice Address - Country:US
Practice Address - Phone:724-689-2341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical