1144373630 NPI number — MRS. MARY CHRISTINE ROBERTSON-HARPER LMHC

Table of content: MRS. MARY CHRISTINE ROBERTSON-HARPER LMHC (NPI 1144373630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144373630 NPI number — MRS. MARY CHRISTINE ROBERTSON-HARPER LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTSON-HARPER
Provider First Name:
MARY
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144373630
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4960 COLLESIUM DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE WORTH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33463-7248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-964-0266
Provider Business Mailing Address Fax Number:
561-969-6907

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4960 COLLESIUM DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE WORTH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33463-7248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-964-0266
Provider Business Practice Location Address Fax Number:
561-969-6907
Provider Enumeration Date:
01/19/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH 7487 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MH 7487 . This is a "DEPT OF HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".