Provider Demographics
NPI:1811755713
Name:ROBERTSON, MADELINE (LMSW)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 HAWTHORNE ST APT 4
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-3746
Mailing Address - Country:US
Mailing Address - Phone:832-425-2737
Mailing Address - Fax:
Practice Address - Street 1:27003 HIDDEN ROCK CT
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-6783
Practice Address - Country:US
Practice Address - Phone:832-425-2737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108778104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker