MEDICARE: TANYA ROBERTS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	33161	TX

General Provider Information

NPI Number	:	1184183709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANYA ROBERTS LCSW

Provider Business Mailing Address
First Line	:	14205 RIVER RD
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78132-2132
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14205 RIVER RD
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78132-2132
Country	:	US
Telephone Number	:	512-956-6779
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2019
Last Update Date	:	03/13/2019

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