Provider Demographics
NPI:1083981898
Name:ROBERT, CHARISSA ROSE (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:CHARISSA
Middle Name:ROSE
Last Name:ROBERT
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MCGILL FERN RD
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:ME
Mailing Address - Zip Code:04084-6529
Mailing Address - Country:US
Mailing Address - Phone:207-318-2324
Mailing Address - Fax:
Practice Address - Street 1:15 SAUNDERS WAY
Practice Address - Street 2:SUITE #720
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4833
Practice Address - Country:US
Practice Address - Phone:207-878-9663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC126081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical