Bruce J. Robertson, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

1992-057 Issued in WI

Practice address

2631 Packerland Dr
Suite 104-C
Green Bay, WI 54313-4130

Phone

(920) 965-7701

Fax

(920) 497-4956

NPI assigned

Jul 11, 2006

Last updated

Sep 12, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1995

Medicare assignment

May accept Medicare assignment

Group practices

Jacob's Well Counseling Center IncGroup PAC ID 1456799006, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jacob's Well Counseling Center Inc

  • Professional Counselor
  • Green Bay, WI
  • NPI 1609558485
  Medicare reassignment Care Compare group NPD
• Family Services of Northeast Wisconsin Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Menasha, WI
  • NPI 1275525925
  NPD (past)
• Family Services of Northeast Wisconsin Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Green Bay, WI
  • NPI 1467453167
  NPD (past)
• Krawczyk Counseling Services, LLC

  • Clinical Social Worker
  • Green Bay, WI
  • NPI 1407001662
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1252713600000",
    "number": "1396770434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2631 PACKERLAND DR",
            "address_2": "SUITE 104-C",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543134130",
            "telephone_number": "920-965-7701",
            "fax_number": "920-497-4956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2631 PACKERLAND DR",
            "address_2": "SUITE 104-C",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543134130",
            "telephone_number": "920-965-7701",
            "fax_number": "920-497-4956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "BRUCE",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2009-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "1992-057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39699400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Teresa A Robbins, LPC, CSAC
• Robert H Wagner Family Dentist S.C.
• Ashley J Roberts, OTR
• Audrey Roberts
• Amanda J Robertson, PA-C
• Cheryl M Robertson
• Mary E Robertson, APNP
• Savana Lorron Robertson
• Tara L Robertson, MS.,PSYD
• Tyler Robertson

• Psychologist in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.