MEDICARE: SYBIL ROBERTSON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904006291	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306035795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYBIL ROBERTSON LCSW

Provider Business Mailing Address
First Line	:	16425 RAVENCHASE WAY
Second Line	:
City	:	MOSELEY
State	:	VA
Zip	:	23120-0019
Country	:	US
Telephone Number	:	804-647-1198
Fax Number	:	804-647-1198

Provider Business Practice Location Address
First Line	:	5309 COMMONWEALTH CENTRE PKWY STE 401
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112-2633
Country	:	US
Telephone Number	:	804-819-4000
Fax Number	:	804-819-4268

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	07/25/2025

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