Provider Demographics
NPI:1194961995
Name:ROBERSON, ANGELA (LCSW)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 S BLUE ANGEL PKWY
Mailing Address - Street 2:#311
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-6045
Mailing Address - Country:US
Mailing Address - Phone:850-293-3985
Mailing Address - Fax:
Practice Address - Street 1:38 S BLUE ANGEL PKWY
Practice Address - Street 2:#311
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-6045
Practice Address - Country:US
Practice Address - Phone:850-293-3985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW92541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical