Provider Demographics
NPI:1912279423
Name:ROBERTSON, BENJAMIN H (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:H
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 WESTERN AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-3700
Mailing Address - Country:US
Mailing Address - Phone:701-335-6005
Mailing Address - Fax:
Practice Address - Street 1:720 WESTERN AVE STE 205
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3700
Practice Address - Country:US
Practice Address - Phone:701-335-6005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID31853104100000X
WYPCSW-6381041C0700X
WYLCSW-9941041C0700X
ND56451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker