Provider Demographics
NPI:1952549685
Name:ROBERTSHAW, GLORIA P (LISW)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:P
Last Name:ROBERTSHAW
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 CRUZ ALTA RD
Mailing Address - Street 2:STE J
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-5947
Mailing Address - Country:US
Mailing Address - Phone:575-737-5533
Mailing Address - Fax:575-737-5534
Practice Address - Street 1:224 CRUZ ALTA RD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-5947
Practice Address - Country:US
Practice Address - Phone:575-737-5533
Practice Address - Fax:575-737-5544
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-054341041C0700X
NMI-05434101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health