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General NPI Number Information
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NPI Number | 1275495749
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Entity Type | Individual
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Provider Name | ROY ROBERSON
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Gender | Male
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 927 N PENNSYLVANIA ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46204-1020
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Country | US
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Telephone | 833-659-4357
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Fax |
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Provider Business Mailing Address
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Address Line | 5845 PETERSEN CT
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-1077
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Country | US
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Telephone | 502-302-0718
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34012492A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 34012492A
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License Number State | IN
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