MEDICARE: PETER D. 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	251S00000X	Community/Behavioral Health Agency	LC3086	ME

General Provider Information

NPI Number	:	1427387752
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER D. ROBERTSON LCSW

Provider Business Mailing Address
First Line	:	PO BOX 96
Second Line	:
City	:	HARRISON
State	:	ME
Zip	:	04040-0096
Country	:	US
Telephone Number	:	207-592-8344
Fax Number	:	207-693-4591

Provider Business Practice Location Address
First Line	:	35 PIONEER STREET
Second Line	:
City	:	WEST PARIS
State	:	ME
Zip	:	04289
Country	:	US
Telephone Number	:	207-592-8344
Fax Number	:	207-693-4591

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	DR. PETER D. ROBERTSON
Credential	:	LCSW
Telephone Number	:	207-592-8344

Provider Enumeration Date	:	12/16/2009
Last Update Date	:	12/16/2009

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