Provider Demographics
NPI:1417429325
Name:ROBERTSON, CHLOE
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BARLOWS LANDING RD
Mailing Address - Street 2:
Mailing Address - City:POCASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02559-1980
Mailing Address - Country:US
Mailing Address - Phone:508-563-5767
Mailing Address - Fax:
Practice Address - Street 1:4 BARLOWS LANDING RD
Practice Address - Street 2:
Practice Address - City:POCASSET
Practice Address - State:MA
Practice Address - Zip Code:02559-1980
Practice Address - Country:US
Practice Address - Phone:508-563-5767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-18
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MA3041-MH-B1103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty