Healthcare Provider Details

I. General information

NPI: 1679641336
Provider Name (Legal Business Name): AMY LYNN ROBERTS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 08/04/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 BELMONT ST, MS 1351
BOISE ID
83706
US

IV. Provider business mailing address

2920 S LEADVILLE AVE
BOISE ID
83706-4742
US

V. Phone/Fax

Practice location:
  • Phone: 208-426-1459
  • Fax:
Mailing address:
  • Phone: 208-869-3857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: