Provider Demographics
NPI:1871641217
Name:ROBERTSON, POLLY JANETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:POLLY
Middle Name:JANETTE
Last Name:ROBERTSON
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 1:8500 N MOPAC EXPY
Mailing Address - Street 2:STE 814
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8348
Mailing Address - Country:US
Mailing Address - Phone:512-748-6127
Mailing Address - Fax:512-792-4862
Practice Address - Street 1:1200 N BISHOP ST
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-2706
Practice Address - Country:US
Practice Address - Phone:512-392-7151
Practice Address - Fax:512-392-5444
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX377411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1859969-01Medicaid
TX37741OtherLCSW LICENSE