Healthcare Provider Details

I. General information

NPI: 1407773435
Provider Name (Legal Business Name): JENNIFER K ROBERTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 WEST ST STE 2
WALPOLE MA
02081-1837
US

IV. Provider business mailing address

55 WEST ST STE 2
WALPOLE MA
02081-1837
US

V. Phone/Fax

Practice location:
  • Phone: 781-269-1019
  • Fax: 508-492-2963
Mailing address:
  • Phone: 781-269-1019
  • Fax: 508-492-2963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER ROBERTS
Title or Position: OWNER
Credential:
Phone: 781-269-1019