Provider Demographics
NPI:1821782772
Name:ROBERTSON, MITCHELLE LEONIE (LPC-A)
Entity Type:Individual
Prefix:
First Name:MITCHELLE
Middle Name:LEONIE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 PRATT ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-8627
Mailing Address - Country:US
Mailing Address - Phone:203-235-5767
Mailing Address - Fax:
Practice Address - Street 1:384 PRATT ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-8627
Practice Address - Country:US
Practice Address - Phone:203-235-5767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6393101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional