Individual
MS. MARY ELISABETH ROBERTSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., LP
Contact information
Practice address
7260 UNIVERSITY AVE NE, SUITE 235, FRIDLEY, MN 55432-3126
(763) 572-2605
(763) 572-2606
Mailing address
1899 20TH AVE NW, NEW BRIGHTON, MN 55112-5432
(651) 633-2774
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP 3004
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
489P9LA
BLUECROSS/BLUESHIELD
MN
Enumeration date
08/31/2006
Last updated
07/09/2007
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