Provider Demographics
NPI:1770128498
Name:ROBERTSON, DARLENE MARIE (REGISTER NURSE)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:MARIE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:REGISTER NURSE
Other - Prefix:MS
Other - First Name:DARLENE
Other - Middle Name:MARIE
Other - Last Name:MCCLEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-3140
Mailing Address - Country:US
Mailing Address - Phone:201-515-0198
Mailing Address - Fax:
Practice Address - Street 1:1545 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-1122
Practice Address - Country:US
Practice Address - Phone:718-613-4447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY606431163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)