Provider Demographics
NPI:1689026239
Name:ROBERSON, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:ROBERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5258 S EASTERN AVE
Mailing Address - Street 2:105
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-2326
Mailing Address - Country:US
Mailing Address - Phone:702-464-5080
Mailing Address - Fax:702-464-5081
Practice Address - Street 1:5258 S EASTERN AVE
Practice Address - Street 2:105
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-2326
Practice Address - Country:US
Practice Address - Phone:702-464-5080
Practice Address - Fax:702-464-5081
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator