Provider Demographics
NPI:1396289971
Name:ROBERTSON, DANIELLE ROSE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:ROSE
Last Name:ROBERTSON
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 1:5328 TROUBLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-5122
Mailing Address - Country:US
Mailing Address - Phone:727-222-0733
Mailing Address - Fax:
Practice Address - Street 1:5328 TROUBLE CREEK RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-5122
Practice Address - Country:US
Practice Address - Phone:727-222-0733
Practice Address - Fax:813-867-7079
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-15
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW17553101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1396289971OtherNPI
FL101YM0800XMedicaid