Provider Demographics
NPI:1427387752
Name:PETER D. ROBERTSON LCSW
Entity Type:Organization
Organization Name:PETER D. ROBERTSON LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-592-8344
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:ME
Mailing Address - Zip Code:04040-0096
Mailing Address - Country:US
Mailing Address - Phone:207-592-8344
Mailing Address - Fax:207-693-4591
Practice Address - Street 1:35 PIONEER STREET
Practice Address - Street 2:
Practice Address - City:WEST PARIS
Practice Address - State:ME
Practice Address - Zip Code:04289
Practice Address - Country:US
Practice Address - Phone:207-592-8344
Practice Address - Fax:207-693-4591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC3086251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health