Provider Demographics
NPI:1548030869
Name:ROBERTSON, MARCUS ANDRE (CNC, BCHHP, CHW)
Entity type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:ANDRE
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:CNC, BCHHP, CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 RUSSEL STREET
Mailing Address - Street 2:UNIT 361
Mailing Address - City:HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01035
Mailing Address - Country:US
Mailing Address - Phone:413-233-5073
Mailing Address - Fax:
Practice Address - Street 1:186 RUSSEL STREET
Practice Address - Street 2:UNIT 361
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035
Practice Address - Country:US
Practice Address - Phone:413-233-5073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education