Provider Demographics
NPI:1730782178
Name:ROBERTSON, EILEEN (REGISTERED CLINICAL)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:REGISTERED CLINICAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6368 SUNNYBROOK BLVD APT A
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34224-8458
Mailing Address - Country:US
Mailing Address - Phone:941-208-5363
Mailing Address - Fax:
Practice Address - Street 1:333 TAMIAMI TRL S STE 301
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2428
Practice Address - Country:US
Practice Address - Phone:941-500-9796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW179581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical