Provider Demographics
NPI:1619772068
Name:ROBERTSON, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:KELLY ROBERTSON NCC
Mailing Address - Street 1:9404 PEEBLES RD
Mailing Address - Street 2:
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101-1931
Mailing Address - Country:US
Mailing Address - Phone:412-969-1380
Mailing Address - Fax:412-969-1380
Practice Address - Street 1:9404 PEEBLES RD
Practice Address - Street 2:
Practice Address - City:ALLISON PARK
Practice Address - State:PA
Practice Address - Zip Code:15101-1931
Practice Address - Country:US
Practice Address - Phone:412-969-1380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health