Provider Demographics
NPI:1386815306
Name:ROBERTSON, KRISTA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:L
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5429 UNIVERSITY PKWY # 1069
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34201-2012
Mailing Address - Country:US
Mailing Address - Phone:941-961-4480
Mailing Address - Fax:941-404-1617
Practice Address - Street 1:320 TREXLER AVE
Practice Address - Street 2:
Practice Address - City:KUTZTOWN
Practice Address - State:PA
Practice Address - Zip Code:19530-9712
Practice Address - Country:US
Practice Address - Phone:941-961-4480
Practice Address - Fax:941-404-1617
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7559103T00000X
FL1004304103TS0200X
PAPS020095103T00000X
FL7559103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool