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General NPI Number Information
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NPI Number | 1881054732
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Entity Type | Individual
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Provider Name | DAVID J ROBERTS LMSW
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Gender | Male
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Dates
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Enumeration Date | 03/03/2016
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Last Update Date | 03/03/2016
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Provider Practice Location Address
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Address Line | 310 E CHESTNUT ST
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City | ROME
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State | NY
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Zip | 13440-3660
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Country | US
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Telephone | 315-335-4592
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Fax |
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Provider Business Mailing Address
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Address Line | 4 HART ST
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City | WHITESBORO
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State | NY
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Zip | 13492-2404
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Country | US
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Telephone | 315-269-4522
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 066397
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License Number State | NY
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