Provider Demographics
NPI:1053679753
Name:REISERT, ROBIN MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:MARIE
Last Name:REISERT
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 1:1745 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-5009
Mailing Address - Country:US
Mailing Address - Phone:941-799-0882
Mailing Address - Fax:
Practice Address - Street 1:1745 4TH ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-5009
Practice Address - Country:US
Practice Address - Phone:941-799-0882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00034751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical