Healthcare Provider Details

I. General information

NPI: 1073478111
Provider Name (Legal Business Name): JUSTIN MICHAEL ROBERTS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 E GERMANN RD
GILBERT AZ
85297-2919
US

IV. Provider business mailing address

934 E PEDRO RD
PHOENIX AZ
85042-7875
US

V. Phone/Fax

Practice location:
  • Phone: 480-613-8802
  • Fax: 480-452-1822
Mailing address:
  • Phone: 480-528-7222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-23366
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: