Provider Demographics
NPI:1457239170
Name:ROBERTS, LAURYN ALICE
Entity type:Individual
Prefix:
First Name:LAURYN
Middle Name:ALICE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2259 NETTLEBROOK ST N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-1009
Mailing Address - Country:US
Mailing Address - Phone:904-524-6845
Mailing Address - Fax:
Practice Address - Street 1:8130 BAYMEADOWS CIR W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-1880
Practice Address - Country:US
Practice Address - Phone:904-608-9881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL182071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical