Healthcare Provider Details

I. General information

NPI: 1124470463
Provider Name (Legal Business Name): KAREN ROBERTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 CRANES ROOST BLVD SUITE 111
ALTAMONTE SPRINGS FL
32701-3418
US

IV. Provider business mailing address

606 SYLVAN RESERVE CV
SANFORD FL
32771-6424
US

V. Phone/Fax

Practice location:
  • Phone: 407-415-6759
  • Fax:
Mailing address:
  • Phone: 407-415-6759
  • Fax: 407-322-0448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH13931
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: