Individual provider Active NPI

Jordan Roberts, LMFT

  • Marriage & Family Therapist
  • Niantic, CT
National Provider Identifier
1356767552
Registry record updated Mar 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
1961 Issued in CT
Practice address
30 W Main St
Niantic, CT 06357-2340
Phone
(860) 691-0873
NPI assigned
Mar 12, 2014
Last updated
Mar 26, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 1961 CT Primary

Addresses

Primary practice location

30 W Main St
Niantic, CT 06357-2340

Mailing address

40 Sunnybrook LN
Clinton, CT 06413-1621
Phone (860) 303-2852

Other practice location 1

74 East St
Plainville, CT 06062-2367
Phone (860) 303-2852

Other practice location 2

481 Gold Star Hwy # 100
Groton, CT 06340-6702
Phone (860) 446-8858

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240216002677 CT Practitioner - Marriage and Family Therapist 3173967205 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The William W Backus HospitalGroup PAC ID 0749170645, 248 clinicians

Practice addresses (Care Compare)

326 Washington St
Norwich, CT 06360-2740
Phone (860) 889-8331

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1961CTMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Windham Community Memorial Hospital, Inc. CurrentSince Jan 1, 2024 Accepting new patients
The William W Backus Hospital CurrentSince Jan 1, 2024 Accepting new patients
William W Backus Hospital CurrentSince Jan 1, 2024 Accepting new patients
Community Health Center Inc Past Accepting new patients
Oceanside Recovery LLC PastSince Jan 9, 2019 Accepting new patients

Locations

326 Washington St
Norwich, CT 06360
Phone (860) 701-0140

1290 Silas Deane Hwy
Wethersfield, CT 06109
Phone (860) 972-6977

112 Mansfield Ave
Willimantic, CT 06226
Phone (830) 423-6410

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1394582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774483200000",
    "number": "1356767552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 SUNNYBROOK LN",
            "city": "CLINTON",
            "state": "CT",
            "postal_code": "064131621",
            "telephone_number": "860-303-2852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 W MAIN ST",
            "city": "NIANTIC",
            "state": "CT",
            "postal_code": "063572340",
            "telephone_number": "860-691-0873"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "74 East St",
            "address_purpose": "LOCATION",
            "city": "Plainville",
            "state": "CT",
            "postal_code": "060622367",
            "country_code": "US",
            "telephone_number": "860-303-2852",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "481 Gold Star Hwy # 100",
            "address_purpose": "LOCATION",
            "city": "Groton",
            "state": "CT",
            "postal_code": "063406702",
            "country_code": "US",
            "telephone_number": "860-446-8858",
            "fax_number": "860-405-2140",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "JORDAN",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-12",
        "last_updated": "2026-03-26",
        "certification_date": "2026-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CT",
            "license": "1961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Niantic, CT

Sources for this page

Verify at the official NPI Registry.