MEDICARE: DR. RACHAEL P ROBERSON PSYD

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	103TC2200X	Clinical Child & Adolescent Psychologist	PSY.0007040	CO

General Provider Information

NPI Number	:	1851222566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RACHAEL P ROBERSON PSYD

Provider Business Mailing Address
First Line	:	4610 SPRING CANYON HTS APT 306
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-3459
Country	:	US
Telephone Number	:	317-285-9567
Fax Number	:

Provider Business Practice Location Address
First Line	:	4610 SPRING CANYON HTS
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-3472
Country	:	US
Telephone Number	:	317-285-9567
Fax Number	:

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

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

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