Provider Demographics
NPI:1144271966
Name:ROBERTSON, DENISE FARANTATOS (LCSW/MSW, QDDP,QMHP)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:FARANTATOS
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:LCSW/MSW, QDDP,QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3304 ASHBY PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1602
Mailing Address - Country:US
Mailing Address - Phone:919-520-3646
Mailing Address - Fax:
Practice Address - Street 1:3900 BARRETT DR STE 301C
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6610
Practice Address - Country:US
Practice Address - Phone:919-520-3646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC004326101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002799Medicaid
NC13650OtherBCBSNC