Provider Demographics
NPI:1508405515
Name:ROBERTSON, KENNETH (LCMHC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 TWIST HILL RD
Mailing Address - Street 2:
Mailing Address - City:DUNBARTON
Mailing Address - State:NH
Mailing Address - Zip Code:03046-4323
Mailing Address - Country:US
Mailing Address - Phone:603-340-5812
Mailing Address - Fax:
Practice Address - Street 1:2013 ELM ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2528
Practice Address - Country:US
Practice Address - Phone:603-627-2702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-23
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2210101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health