NPIMap

Individual provider Active NPI

Otis Lamonte Roberson II, LCSW-A

  • Clinical Social Worker
  • Burlington, NC
National Provider Identifier
1659902393
Registry record updated Apr 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
P014268 Issued in NC
Practice address
2008 S Mebane St Apt E
Burlington, NC 27215-7614
Phone
(704) 352-1939
Fax
(844) 272-1223
NPI assigned
Jan 31, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X P014268 NC Primary

Addresses

Primary practice location

2008 S Mebane St Apt E
Burlington, NC 27215-7614

Mailing address

2008 S Mebane St Apt E
Burlington, NC 27215-7614
Phone (704) 352-1939

Other practice location 1

1045 S Church St
Burlington, NC 27215-5045
Phone (336) 270-6116

Other names 1

  • Mr. Otis Lamonte Roberson II Former name

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
P014268NCMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Little-Gerald Services PastSince Feb 1, 2020 Accepting new patients
Little-Gerald Services PastSince Feb 1, 2020 Accepting new patients

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1580428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586304000000",
    "number": "1659902393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2008 S MEBANE ST APT E",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "272157614",
            "telephone_number": "704-352-1939",
            "fax_number": "844-272-1223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2008 S MEBANE ST APT E",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "272157614",
            "telephone_number": "704-352-1939",
            "fax_number": "844-272-1223"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1045 S Church St",
            "address_purpose": "LOCATION",
            "city": "Burlington",
            "state": "NC",
            "postal_code": "272155045",
            "country_code": "US",
            "telephone_number": "336-270-6116",
            "fax_number": "844-272-1223",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROBERSON",
        "first_name": "OTIS",
        "middle_name": "LAMONTE",
        "name_prefix": "Mr.",
        "name_suffix": "II",
        "credential": "LCSW-A",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-01-31",
        "last_updated": "2020-04-08",
        "certification_date": "2020-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P014268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "OTIS",
            "last_name": "ROBERSON",
            "middle_name": "LAMONTE",
            "prefix": "MR.",
            "suffix": "II",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Burlington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2020; 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.