Individual provider Active NPI

Eric Roberson, LSW

  • Clinical Social Worker
  • Tacoma, WA
National Provider Identifier
1760874465
Registry record updated Mar 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
10565 Issued in PR
Practice address
9600 Veterans Dr SW
Tacoma, WA 98493-0003
Phone
(253) 582-8440
Fax
(253) 589-4075
NPI assigned
Mar 4, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2015

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 10565 PR Primary

Addresses

Primary practice location

9600 Veterans Dr SW
Tacoma, WA 98493-0003

Mailing address

9600 Veterans Dr SW
Tacoma, WA 98493-0003
Phone (253) 582-8440

Other identifiers 1

IdentifierTypeStateIssuer
1041C0700XOtherWAVETERAN'S AFFAIRS

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
10565PRMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1425427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425427200000",
    "number": "1760874465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9600 VETERANS DR SW",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984930003",
            "telephone_number": "253-582-8440",
            "fax_number": "253-589-4075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9600 VETERANS DR SW",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984930003",
            "telephone_number": "253-582-8440",
            "fax_number": "253-589-4075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERSON",
        "first_name": "ERIC",
        "name_prefix": "Mr.",
        "credential": "LSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-04",
        "last_updated": "2015-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PR",
            "license": "10565",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VETERAN'S AFFAIRS",
            "identifier": "1041C0700X",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2015; 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.