Provider Demographics
NPI:1629134879
Name:ROBERTSON, JON MICHAEL (LCSW)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:MICHAEL
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 1:808 N GRANDVIEW AVE
Mailing Address - Street 2:P.O. BOX 3004
Mailing Address - City:MCKEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15132-1602
Mailing Address - Country:US
Mailing Address - Phone:412-678-4039
Mailing Address - Fax:
Practice Address - Street 1:6324 MARCHAND ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-4312
Practice Address - Country:US
Practice Address - Phone:412-661-1239
Practice Address - Fax:412-661-1304
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0142331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical