Provider Demographics
NPI:1023416161
Name:ROBERTSON, AMY REBECCA (PSYD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:REBECCA
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21903 PANAMA CITY BEACH PARKWAY
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32413
Mailing Address - Country:US
Mailing Address - Phone:850-359-3882
Mailing Address - Fax:
Practice Address - Street 1:21903 PANAMA CITY BEACH PARKWAY
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413
Practice Address - Country:US
Practice Address - Phone:850-359-3882
Practice Address - Fax:850-390-7181
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-05
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS54948103T00000X, 103TC0700X
COPSY0005770103T00000X
FLPY10082103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical