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General NPI Number Information
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NPI Number | 1023416161
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Entity Type | Individual
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Provider Name | AMY REBECCA ROBERTSON PSYD
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Gender | Female
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Dates
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Enumeration Date | 12/05/2014
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Last Update Date | 05/04/2022
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Provider Practice Location Address
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Address Line | 21903 PANAMA CITY BEACH PARKWAY
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32413
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Country | US
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Telephone | 850-359-3882
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Fax | 850-390-7181
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Provider Business Mailing Address
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Address Line | 21903 PANAMA CITY BEACH PARKWAY
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32413
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Country | US
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Telephone | 850-359-3882
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 54948
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY0005770
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 54948
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License Number State | MS
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY10082
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY10082
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License Number State | FL
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