Healthcare Provider Details

I. General information

NPI: 1750272746
Provider Name (Legal Business Name): JAMES R ROBERTS JR. LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
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
FORT LAUDERDALE FL
33319-2900
US

V. Phone/Fax

Practice location:
  • Phone: 954-612-2814
  • Fax: 954-990-7650
Mailing address:
  • Phone: 754-400-0824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW27230
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: