Healthcare Provider Details

I. General information

NPI: 1316351190
Provider Name (Legal Business Name): ROBERTSON AND ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4019 CLARCONA OCOEE RD
ORLANDO FL
32810-4270
US

IV. Provider business mailing address

4019 CLARCONA OCOEE RD
ORLANDO FL
32810-4270
US

V. Phone/Fax

Practice location:
  • Phone: 407-297-1185
  • Fax: 888-694-3421
Mailing address:
  • Phone: 407-297-1185
  • Fax: 888-694-3421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY8017
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN F. ROBERTSON
Title or Position: PSYCHOLOGIST
Credential: PH. D.
Phone: 407-297-1185