Individual provider Active NPI

Keyana Jackee' Roberts, LMSW-C

  • Clinical Social Worker
  • Saginaw, MI
National Provider Identifier
1245749043
Registry record updated Nov 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801119104 Issued in MI
Practice address
500 Hancock Street
Saginaw, MI 48602-4224
Phone
(989) 797-3400
Fax
(989) 799-0206
NPI assigned
Sep 25, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X
Social Worker 104100000X 6801102883 MI
Clinical Social Worker 1041C0700X 6801119104 MI Primary

Addresses

Primary practice location

500 Hancock Street
Saginaw, MI 48602-4224

Mailing address

500 Hancock Street
Saginaw, MI 48602-4224
Phone (989) 797-3400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
6801102883MIMDSocial Worker
6801119104MIMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1506297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731283200000",
    "number": "1245749043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 HANCOCK STREET",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486024224",
            "telephone_number": "989-797-3400",
            "fax_number": "989-799-0206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 HANCOCK STREET",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486024224",
            "telephone_number": "989-797-3400",
            "fax_number": "989-799-0206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "KEYANA",
        "middle_name": "JACKEE'",
        "credential": "LMSW-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-25",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801102883",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801119104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saginaw, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.