Provider Demographics
NPI:1629125612
Name:ROBERTSON, RITA H (LISW)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:H
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-1122
Mailing Address - Country:US
Mailing Address - Phone:513-751-6698
Mailing Address - Fax:
Practice Address - Street 1:130 WELLINGTON PL
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1710
Practice Address - Country:US
Practice Address - Phone:513-381-6611
Practice Address - Fax:513-381-7818
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-1404101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health