| Doctor Name: | AMY R ROBERTSON |
| NPI Number: | 1023416161 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | 54948 |
| Business Practice Address: | 1 Lincoln Pkwy Ste 204 Hattiesburg, MS - 394023261 |
| Business Phone Number: | 6012884772 |
| Business Fax Number: | |
| Mailing Address: | 1 Lincoln Pkwy Ste 204, HATTIESBURG |
| State: | MS |
| Postal Code: | 394023261 |
| Phone Number: | 6012884772 |
| Fax Number: | |
| NPI Enumeration Date: | 12/05/2014 |
| NPI Last Update Date: | 12/05/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 54948 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |