Basic Information
| Provider Information | |||||||||
| NPI: | 1629134879 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBERTSON | ||||||||
| FirstName: | JON | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 808 N GRANDVIEW AVE | ||||||||
| Address2: | P.O. BOX 3004 | ||||||||
| City: | MCKEESPORT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151321602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126784039 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6324 MARCHAND ST | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152064312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126611239 | ||||||||
| FaxNumber: | 4126611304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2006 | ||||||||
| LastUpdateDate: | 04/26/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CW014233 | PA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.