Provider Demographics
NPI:1164996542
Name:ROBERTSON, SEAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:PSYD
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 504
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-0504
Mailing Address - Country:US
Mailing Address - Phone:971-385-1834
Mailing Address - Fax:
Practice Address - Street 1:1010 W CHARLES ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2530
Practice Address - Country:US
Practice Address - Phone:971-385-1834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3737103TC0700X
ORR161103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical