Provider Demographics
NPI:1962146159
Name:ROBERTSON-EBRON, CLEO A (MSED ESE)
Entity type:Individual
Prefix:
First Name:CLEO
Middle Name:A
Last Name:ROBERTSON-EBRON
Suffix:
Gender:F
Credentials:MSED ESE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 LAKE COMO DR
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4819
Mailing Address - Country:US
Mailing Address - Phone:646-334-6531
Mailing Address - Fax:
Practice Address - Street 1:844 LAKE COMO DR
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4819
Practice Address - Country:US
Practice Address - Phone:646-334-6531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-24
Last Update Date:2022-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty