MEDICARE: MRS. KAREN BONITA ROBERTS CMSW, LADAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LADAC959	TN
2	104100000X	Social Worker	CMSW6205	TN

General Provider Information

NPI Number	:	1194913277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAREN BONITA ROBERTS CMSW, LADAC

Provider Business Mailing Address
First Line	:	1017 MITCHELL RD
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37206-1113
Country	:	US
Telephone Number	:	615-306-2414
Fax Number	:

Provider Business Practice Location Address
First Line	:	1017 MITCHELL RD
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37206-1113
Country	:	US
Telephone Number	:	615-306-2414
Fax Number	:

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

Provider Enumeration Date	:	10/14/2007
Last Update Date	:	10/14/2007

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