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NPI Code Detail

MEDICARE: BREANNE S ROBERTS LMSW

MEDICARE: BREANNE S ROBERTS LMSW
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 Worker6801093508MI

General Provider Information

NPI Number : 1457602476
Entity Type Code : Individual
Provider Name (Legal Business Name) : BREANNE S ROBERTS LMSW
Provider Business Mailing Address
First Line : 5005 PLAINFIELD AVE NE STE 100
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49525-2087
Country : US
Telephone Number :
Fax Number : 855-693-4641
Provider Business Practice Location Address
First Line : 5005 PLAINFIELD AVE NE STE 100
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49525-2087
Country : US
Telephone Number : 231-753-8823
Fax Number : 855-693-4641
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2012
Last Update Date : 02/24/2025

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Directions to “ BREANNE S ROBERTS LMSW” Practice Location

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