Healthcare Provider Details

I. General information

NPI: 1871641217
Provider Name (Legal Business Name): POLLY JANETTE ROBERTSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N BISHOP ST
SAN MARCOS TX
78666-2706
US

IV. Provider business mailing address

8500 N MOPAC EXPY STE 814
AUSTIN TX
78759-8348
US

V. Phone/Fax

Practice location:
  • Phone: 512-392-7151
  • Fax: 512-392-5444
Mailing address:
  • Phone: 512-748-6127
  • Fax: 512-792-4862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number37741
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: