Healthcare Provider Details

I. General information

NPI: 1417456807
Provider Name (Legal Business Name): ONESSA ROBERTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 ROOSEVELT BLVD
CLEARWATER FL
33760
US

IV. Provider business mailing address

PO BOX 10970
ST PETERSBURG FL
33733-0970
US

V. Phone/Fax

Practice location:
  • Phone: 727-327-7656
  • Fax: 727-322-2110
Mailing address:
  • Phone: 727-327-7656
  • Fax: 727-322-2110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW15679
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: