MEDICARE: AMY MICHELLE ROBERTS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	9227	TN

General Provider Information

NPI Number	:	1073250395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY MICHELLE ROBERTS LCSW

Provider Business Mailing Address
First Line	:	1211 KING SPRINGS RD APT 606
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-9606
Country	:	US
Telephone Number	:	423-946-4938
Fax Number	:

Provider Business Practice Location Address
First Line	:	1211 KING SPRINGS RD APT 606
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-9606
Country	:	US
Telephone Number	:	423-946-4938
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2022
Last Update Date	:	09/09/2024

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