Provider Demographics
NPI:1790372183
Name:ROBERTSON, CRYSTAL MARLENE (RBT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MARLENE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 13TH PL SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-6427
Mailing Address - Country:US
Mailing Address - Phone:772-618-3854
Mailing Address - Fax:
Practice Address - Street 1:218 13TH PL SW
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32962-6427
Practice Address - Country:US
Practice Address - Phone:772-618-3854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician