Provider Demographics
NPI:1720345887
Name:ROBERTSON, PENNIE LYNN (LCSW, CART)
Entity type:Individual
Prefix:MRS
First Name:PENNIE
Middle Name:LYNN
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:LCSW, CART
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 PR 4775
Mailing Address - Street 2:
Mailing Address - City:CASTROVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78009-2813
Mailing Address - Country:US
Mailing Address - Phone:210-625-2364
Mailing Address - Fax:830-931-2714
Practice Address - Street 1:11020 D HANIS AVE.
Practice Address - Street 2:
Practice Address - City:LACOSTE
Practice Address - State:TX
Practice Address - Zip Code:78039
Practice Address - Country:US
Practice Address - Phone:210-625-2364
Practice Address - Fax:830-931-2714
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX366811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical