Provider Demographics
NPI:1578694816
Name:ROBERTSON, DAVID EDWARD (LCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:EDWARD
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24
Mailing Address - Street 2:
Mailing Address - City:PILOT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95664-0024
Mailing Address - Country:US
Mailing Address - Phone:916-521-8667
Mailing Address - Fax:530-887-1637
Practice Address - Street 1:1230 HIGH ST
Practice Address - Street 2:STE 120B
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-5043
Practice Address - Country:US
Practice Address - Phone:916-521-8667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS114171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical