Healthcare Provider Details

I. General information

NPI: 1376941930
Provider Name (Legal Business Name): ALVIN ROBERTSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2014
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 VILLAGE BLVD, SUITE 905-358
WEST PALM BEACH FL
33409-1803
US

IV. Provider business mailing address

4575 SE DIXIE HWY
STUART FL
34997-6826
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax: 772-675-9100
Mailing address:
  • Phone: 855-832-6727
  • Fax: 772-675-9100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12155452
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: