Provider Demographics
NPI:1023185527
Name:ROBERTSON, KANDI (LMSW)
Entity Type:Individual
Prefix:
First Name:KANDI
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:LMSW
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 82
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04643-0082
Mailing Address - Country:US
Mailing Address - Phone:207-483-4502
Mailing Address - Fax:207-483-4778
Practice Address - Street 1:81 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRINGTON
Practice Address - State:ME
Practice Address - Zip Code:04643-3000
Practice Address - Country:US
Practice Address - Phone:207-483-4502
Practice Address - Fax:207-483-4778
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC9905104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME297830099Medicaid