Provider Demographics
NPI:1609105295
Name:ROBERTSON, ROCHELLE KATHLEEN
Entity Type:Individual
Prefix:MRS
First Name:ROCHELLE
Middle Name:KATHLEEN
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 1:12505 TAMARAC TRL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-6248
Mailing Address - Country:US
Mailing Address - Phone:505-710-2545
Mailing Address - Fax:
Practice Address - Street 1:2612 TEXAS ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4684
Practice Address - Country:US
Practice Address - Phone:505-830-1871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health