Provider Demographics
NPI:1366130916
Name:ROBERTSON, EMILY LYNNE (PHD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:LYNNE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5345 97TH STREET CIR E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-3783
Mailing Address - Country:US
Mailing Address - Phone:904-707-9888
Mailing Address - Fax:
Practice Address - Street 1:5345 97TH STREET CIR E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-3783
Practice Address - Country:US
Practice Address - Phone:904-707-9888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY11854103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent