MEDICARE: JENNIFER 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
1	104100000X	Social Worker	M7462	MS

General Provider Information

NPI Number	:	1952767634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ROBERTS LMSW

Provider Business Mailing Address
First Line	:	1867 CRANE RIDGE DR STE 150C
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39216-4982
Country	:	US
Telephone Number	:	662-350-3914
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 S GLOSTER ST
Second Line	:
City	:	TUPELO
State	:	MS
Zip	:	38801-5528
Country	:	US
Telephone Number	:	662-350-3914
Fax Number	:

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

Provider Enumeration Date	:	01/11/2016
Last Update Date	:	03/05/2026

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