MEDICARE: CAITLAIN MARIE 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	101YM0800X	Mental Health Counselor	10546	NE
2	101YM0800X	Mental Health Counselor	6986	NE
3	104100000X	Social Worker	11232	TN
4	1041C0700X	Clinical Social Worker	LSW7670	TN

General Provider Information

NPI Number	:	1568845352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLAIN MARIE ROBERTS LCSW

Provider Business Mailing Address
First Line	:	2720 BRITT LN
Second Line	:
City	:	MORRISTOWN
State	:	TN
Zip	:	37814-2146
Country	:	US
Telephone Number	:	402-366-6444
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 W 1ST NORTH ST
Second Line	:
City	:	MORRISTOWN
State	:	TN
Zip	:	37814-4634
Country	:	US
Telephone Number	:	402-366-6444
Fax Number	:

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

Provider Enumeration Date	:	06/30/2015
Last Update Date	:	08/15/2022

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