Provider Demographics
NPI:1528736337
Name:ROBERTSON, KAILA NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:KAILA
Middle Name:NICOLE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PINK CLOUD CT
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-3310
Mailing Address - Country:US
Mailing Address - Phone:919-260-5169
Mailing Address - Fax:
Practice Address - Street 1:12303 AIRPORT WAY STE 125
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-2729
Practice Address - Country:US
Practice Address - Phone:970-310-3406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-06
Last Update Date:2023-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1566621104100000X
CT133871041C0700X
CO099297911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT13387OtherCONNECTICUT DEPARTMENT OF PUBLIC HEALTH
CO09929791OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES
NY1566621OtherNEW YORK LMSW