Provider Demographics
NPI:1881837276
Name:ROBERTSON, ISCHAJI NYERERE (PSYD)
Entity Type:Individual
Prefix:
First Name:ISCHAJI
Middle Name:NYERERE
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15321 S DIXIE HWY
Mailing Address - Street 2:SUITE 303A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1814
Mailing Address - Country:US
Mailing Address - Phone:786-586-3818
Mailing Address - Fax:
Practice Address - Street 1:15321 S DIXIE HWY
Practice Address - Street 2:SUITE 303A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-1814
Practice Address - Country:US
Practice Address - Phone:786-586-3818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6163103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical