Provider Demographics
NPI:1902015654
Name:ROBERTSON, SADIE ANNA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SADIE
Middle Name:ANNA
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SADIE
Other - Middle Name:ANNA
Other - Last Name:DOLLOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:23 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6935
Mailing Address - Country:US
Mailing Address - Phone:978-394-1290
Mailing Address - Fax:
Practice Address - Street 1:23 WILLOW ST
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6935
Practice Address - Country:US
Practice Address - Phone:978-394-1290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC114201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME417150099Medicaid