Active NPI
Darrell Dewayne Robertson
- Social Worker
- Poplar Bluff, MO
National Provider Identifier
1982997599
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 2011012790
- Practice address
- 2725 N Westwood Blvd
Ste.5a
Poplar Bluff, MO 63901-2346 - Phone
- (573) 785-0333
- NPI assigned
- May 16, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 2011012790 | MO | Primary |
Addresses
Primary practice location
2725 N Westwood Blvd
Ste.5a
Poplar Bluff, MO 63901-2346
Mailing address
2725 N Westwood Blvd
Ste.5a
Poplar Bluff, MO 63901-2346
Phone (573) 785-0333
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
| License | State | Type | Specialty |
|---|---|---|---|
| 2011012790 | MO | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Solid Rock Christian Counseling, Inc | Social Worker | Past | Accepting new patients |
| Solid Rock Christian Counseling, Inc | Past | 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.
-
- Social Worker
- Poplar Bluff, MO
- NPI 1427341510
-
- Mental Health Counselor
- Poplar Bluff, MO
- NPI 1699836403
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1305504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305504000000",
"number": "1982997599",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2725 N WESTWOOD BLVD",
"address_2": "STE.5A",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639012346",
"telephone_number": "573-785-0333"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2725 N WESTWOOD BLVD",
"address_2": "STE.5A",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639012346",
"telephone_number": "573-785-0333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTSON",
"first_name": "DARRELL",
"middle_name": "DEWAYNE",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-05-16",
"last_updated": "2011-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MO",
"license": "2011012790",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Poplar Bluff, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.