Healthcare Provider Details

I. General information

NPI: 1245714641
Provider Name (Legal Business Name): JENNIFER ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 WEBSTER ST
NEEDHAM MA
02494-1196
US

IV. Provider business mailing address

609 WEBSTER ST
NEEDHAM MA
02494-1196
US

V. Phone/Fax

Practice location:
  • Phone: 781-455-0800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number118371-SW-LICSW
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: