Healthcare Provider Details

I. General information

NPI: 1285538587
Provider Name (Legal Business Name): JAMES ROBERTS MENTAL WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5155 E SABAL PALM BLVD APT 109
TAMARAC FL
33319-2666
US

IV. Provider business mailing address

5440 N STATE ROAD 7 STE 215 PMB 1036
FORT LAUDERDALE FL
33319-2900
US

V. Phone/Fax

Practice location:
  • Phone: 754-400-0824
  • Fax:
Mailing address:
  • Phone: 754-400-0824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAMES RANDALL ROBERTS JR.
Title or Position: OWNER
Credential: LCSW
Phone: 754-400-0824