Provider Demographics
NPI:1912928300
Name:ROBERTSON, SUSAN B
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:B
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3014 ROSE CREEK CT
Mailing Address - Street 2:PO BOX 177
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-1782
Mailing Address - Country:US
Mailing Address - Phone:703-938-5547
Mailing Address - Fax:703-938-7624
Practice Address - Street 1:2915 HUNTER MILL RD
Practice Address - Street 2:STE 14
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-1716
Practice Address - Country:US
Practice Address - Phone:703-938-5547
Practice Address - Fax:703-938-7624
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040019701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical