Provider Demographics
NPI:1154685105
Name:ROBERTSON, BOZENA EVA (PHD)
Entity type:Individual
Prefix:DR
First Name:BOZENA
Middle Name:EVA
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:694 N COVE DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-3901
Mailing Address - Country:US
Mailing Address - Phone:585-322-5481
Mailing Address - Fax:
Practice Address - Street 1:490 EAST RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:ROCHSTER
Practice Address - State:NY
Practice Address - Zip Code:14621-1297
Practice Address - Country:US
Practice Address - Phone:585-922-2623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2016-04-05
Deactivation Date:2016-03-29
Deactivation Code:
Reactivation Date:2016-04-05
Provider Licenses
StateLicense IDTaxonomies
NY001367101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health