Provider Demographics
NPI:1124470463
Name:ROBERTSON, KAREN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 SYLVAN RESERVE CV
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-6424
Mailing Address - Country:US
Mailing Address - Phone:407-415-6759
Mailing Address - Fax:407-322-0448
Practice Address - Street 1:283 CRANES ROOST BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-3418
Practice Address - Country:US
Practice Address - Phone:407-415-6759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13931101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health