Provider Demographics
NPI:1770855694
Name:ROBSON, MARY J (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:ROBSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3574 US 1 S
Mailing Address - Street 2:SUITE 113
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-6466
Mailing Address - Country:US
Mailing Address - Phone:904-797-3115
Mailing Address - Fax:904-797-2915
Practice Address - Street 1:3574 US 1 S
Practice Address - Street 2:SUITE 113
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-6466
Practice Address - Country:US
Practice Address - Phone:904-797-3115
Practice Address - Fax:904-797-2915
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW59391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical