Provider Demographics
NPI:1568018216
Name:ROBERTSON, TRICIA M
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:M
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 1:9261 FAIRLAWN ST
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-3216
Mailing Address - Country:US
Mailing Address - Phone:619-493-6077
Mailing Address - Fax:
Practice Address - Street 1:9261 FAIRLAWN ST
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-3216
Practice Address - Country:US
Practice Address - Phone:619-493-6077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health