Provider Demographics
NPI:1942439666
Name:ROBERTSON, JOHN F (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5104 N ORANGE BLOSSOM TRL
Mailing Address - Street 2:SUITE 222
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-1042
Mailing Address - Country:US
Mailing Address - Phone:407-297-1185
Mailing Address - Fax:
Practice Address - Street 1:5104 N ORANGE BLOSSOM TRL
Practice Address - Street 2:SUITE 222
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-1042
Practice Address - Country:US
Practice Address - Phone:407-297-1185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8017103TC0700X
NY8474103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)