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NPI Code Detail

MEDICARE: MR. EMMETT REAFORD ROBERTS JR. MSW, ACSW, LCSW

MEDICARE: MR. EMMETT REAFORD ROBERTS JR. MSW, ACSW, 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
11041C0700XClinical Social Worker1640OK

General Provider Information

NPI Number : 1285620377
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EMMETT REAFORD ROBERTS JR. MSW, ACSW, LCSW
Provider Business Mailing Address
First Line : 1421 NW 105TH TER
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73114-5205
Country : US
Telephone Number : 405-752-7079
Fax Number :
Provider Business Practice Location Address
First Line : 1209 SOVEREIGN ROW
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73108-1824
Country : US
Telephone Number : 405-942-5570
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2005
Last Update Date : 07/08/2007

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