Provider Demographics
NPI:1568672350
Name:ROBERTSON, MICHELLE KATALIN (LICSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KATALIN
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 EASTBROOK RD STE 302
Mailing Address - Street 2:RIVERSIDE COMMUNITY CARE
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-2084
Mailing Address - Country:US
Mailing Address - Phone:781-329-4579
Mailing Address - Fax:781-329-8631
Practice Address - Street 1:30 EASTBROOK RD STE 302
Practice Address - Street 2:RIVERSIDE COMMUNITY CARE
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-2084
Practice Address - Country:US
Practice Address - Phone:781-329-4579
Practice Address - Fax:781-329-8631
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1200331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical