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NPI Code Detail

MEDICARE: NATHANAEL ROBERTSON LCSW

MEDICARE:   NATHANAEL  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 Worker108075TX

General Provider Information

NPI Number : 1669109880
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATHANAEL ROBERTSON LCSW
Provider Business Mailing Address
First Line : 5900 BALCONES DR STE 100
Second Line :
City : AUSTIN
State : TX
Zip : 78731-4298
Country : US
Telephone Number : 512-736-6430
Fax Number :
Provider Business Practice Location Address
First Line : 7424 E HWY 290
Second Line :
City : AUSTIN
State : TX
Zip : 78723-1571
Country : US
Telephone Number : 512-814-8282
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2022
Last Update Date : 01/27/2026

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Directions to “ NATHANAEL ROBERTSON LCSW” Practice Location

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