Provider Demographics
NPI:1215443395
Name:ROBERTSON, JULIA (BCBA)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:PARKESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:19365-1246
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 S HENDERSON RD.
Practice Address - Street 2:#208
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-3596
Practice Address - Country:US
Practice Address - Phone:267-432-9354
Practice Address - Fax:610-768-0619
Is Sole Proprietor?:No
Enumeration Date:2017-12-27
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-16-1380-31914106S00000X
1-22-62246103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician