Provider Demographics
NPI:1508984774
Name:ROBSON, CHARLOTTE ELEANOR (PHD)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:ELEANOR
Last Name:ROBSON
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 1:30500 LONGCREST STREET
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-1596
Mailing Address - Country:US
Mailing Address - Phone:248-646-5753
Mailing Address - Fax:
Practice Address - Street 1:725 SOUTH ADAMS ROAD
Practice Address - Street 2:SUITE 250
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6926
Practice Address - Country:US
Practice Address - Phone:248-433-1560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005643103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF34814OtherBC
MIOM93760Medicare ID - Type Unspecified