Provider Demographics
NPI:1295363414
Name:ROBERTSON, RACHEL FARRON (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:FARRON
Last Name:ROBERTSON
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 1:12270 MARTY STUART DR
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-8947
Mailing Address - Country:US
Mailing Address - Phone:601-562-0399
Mailing Address - Fax:
Practice Address - Street 1:25117 HIGHWAY 15
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MS
Practice Address - Zip Code:39365-9088
Practice Address - Country:US
Practice Address - Phone:601-774-8214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC83771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical