MEDICARE: KAMI M. ROBERTS

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	R064176-1	NY

General Provider Information

NPI Number	:	1871803221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAMI M. ROBERTS

Provider Business Mailing Address
First Line	:	1275 E 51ST ST
Second Line	:	APT. 7X
City	:	BROOKLYN
State	:	NY
Zip	:	11234-2246
Country	:	US
Telephone Number	:	347-204-8604
Fax Number	:

Provider Business Practice Location Address
First Line	:	1114 FULTON ST
Second Line	:	2ND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11238-2607
Country	:	US
Telephone Number	:	347-204-8604
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. KAMI MEICORO ROBERTS
Credential	:	LCSW-R
Telephone Number	:	347-204-8604

Provider Enumeration Date	:	10/19/2010
Last Update Date	:	10/19/2010

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