Healthcare Provider Details

I. General information

NPI: 1700306735
Provider Name (Legal Business Name): MARC ROBSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 09/01/2025
Certification Date: 09/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 PASEO VISTA LOOP NE
RIO RANCHO NM
87124-4526
US

IV. Provider business mailing address

128 PASEO VISTA LOOP NE
RIO RANCHO NM
87124-4526
US

V. Phone/Fax

Practice location:
  • Phone: 850-543-4938
  • Fax:
Mailing address:
  • Phone: 850-543-4938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2023-0374
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: