Provider Demographics
NPI:1720835580
Name:ROBERTSON, AYANNA (MHC-LP)
Entity type:Individual
Prefix:
First Name:AYANNA
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1091
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-0991
Mailing Address - Country:US
Mailing Address - Phone:516-927-7898
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1091
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-0991
Practice Address - Country:US
Practice Address - Phone:516-927-7898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health