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NPI Code Detail

MEDICARE: MARY ROBERTSON LCSW

MEDICARE: MARY 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
11041C0700XClinical Social Worker1603CAL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1515 38765OTHERALBLUE CROSS

General Provider Information

NPI Number : 1396790473
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ROBERTSON LCSW
Provider Business Mailing Address
First Line : 1040 LONGFIELD CT
Second Line :
City : MONTGOMERY
State : AL
Zip : 36117-8055
Country : US
Telephone Number : 334-288-9009
Fax Number : 334-288-9497
Provider Business Practice Location Address
First Line : 1040 LONGFIELD CT
Second Line :
City : MONTGOMERY
State : AL
Zip : 36117-8055
Country : US
Telephone Number : 334-288-9009
Fax Number : 334-288-9497
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2006
Last Update Date : 02/12/2013

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Directions to “ MARY ROBERTSON LCSW” Practice Location

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