| Jeffrey R Robertson Inc | |
|
6840 Prairie Run Ave Portage IN 46368-2665 | |
| (219) 763-4767 | |
| Not Available |
| Full Name | Jeffrey R Robertson Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 6840 Prairie Run Ave, Portage, Indiana |
| Authorized Official Name and Position | Jeffrey R Robertson (LCSW) |
| Authorized Official Contact | 2197634767 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jeffrey R Robertson Inc 6840 Prairie Run Ave Portage IN 46368-2665 Ph: (219) 763-4767 | Jeffrey R Robertson Inc 6840 Prairie Run Ave Portage IN 46368-2665 Ph: (219) 763-4767 |
| NPI Number | 1194976100 |
|---|---|
| Provider Enumeration Date | 10/08/2008 |
| Last Update Date | 02/03/2009 |
| Medicare PECOS PAC ID | 8820085798 |
|---|---|
| Medicare Enrollment ID | O20090210000665 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194976100 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 34001418A (Indiana) | Primary |
| Provider Name | Jeffrey R Robertson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578513438 PECOS PAC ID: 4082601950 Enrollment ID: I20040527001043 |
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