Healthcare Provider Details

I. General information

NPI: 1588747158
Provider Name (Legal Business Name): JOHN ARTHUR ROBERTS MSW, LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N MILFORD RD SUITE 100
MILFORD MI
48381-1047
US

IV. Provider business mailing address

4844 ELIZABETH LAKE RD
WATERFORD MI
48327-2736
US

V. Phone/Fax

Practice location:
  • Phone: 248-684-6400
  • Fax: 248-684-5973
Mailing address:
  • Phone: 248-875-9174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801079077
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: