Provider Demographics
NPI:1699404491
Name:ROBERTS, JEREMY ALLAN
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:ALLAN
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9495 HARVARD BLVD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44514-3369
Mailing Address - Country:US
Mailing Address - Phone:855-292-9778
Mailing Address - Fax:
Practice Address - Street 1:9495 HARVARD BLVD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514-3369
Practice Address - Country:US
Practice Address - Phone:855-292-9778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator