Healthcare Provider Details

I. General information

NPI: 1770487266
Provider Name (Legal Business Name): DEMETRIA NOCHELLE JIMERSON-ROBERTS LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W MAIN ST APT 322
CARMEL IN
46032-1589
US

IV. Provider business mailing address

1111 W MAIN ST APT 322
CARMEL IN
46032-1589
US

V. Phone/Fax

Practice location:
  • Phone: 317-526-0554
  • Fax:
Mailing address:
  • Phone: 317-526-0554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: