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General NPI Number Information
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NPI Number | 1407027279
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Entity Type | Individual
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Provider Name | MARY CECILIA ROBERTSON PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/19/2008
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Last Update Date | 11/06/2009
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Provider Practice Location Address
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Address Line | 6420 SOUTHWEST BLVD SUITE 112
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City | FORT WORTH
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State | TX
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Zip | 76109
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Country | US
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Telephone | 817-877-0033
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Fax | 817-877-0032
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Provider Business Mailing Address
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Address Line | 3261 ODESSA AVE
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City | FORT WORTH
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State | TX
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Zip | 76109-2219
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Country | US
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Telephone | 817-877-0033
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Fax | 817-877-0032
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 24311
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License Number State | TX
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