Dacarie Robertson, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

L11101 Issued in OR

Practice address

713 Summit Ave
Medford, OR 97501-2349

Phone

(541) 535-6239

NPI assigned

Jan 2, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Mar 18, 2024 through Mar 18, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Inner Flow Counseling LLC

  • Clinical Social Worker
  • Medford, OR
  • NPI 1437961562
  NPD Authorized official
• La Clinica del Valle Family Health Care Center Inc.

  • Federally Qualified Health Center (FQHC)
  • Medford, OR
  • NPI 1497090971
  NPD (past)
• La Clinica del Valle Family Health Care Center Inc.

  • Federally Qualified Health Center (FQHC)
  • Medford, OR
  • NPI 1851327571
  NPD (past)

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

{
    "created_epoch": "1325462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662681600000",
    "number": "1477823896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "931 CHEVY WAY",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975044127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "713 SUMMIT AVE",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975012349",
            "telephone_number": "541-535-6239"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1911 Hazel Ave",
            "address_purpose": "LOCATION",
            "city": "Medford",
            "state": "OR",
            "postal_code": "975011630",
            "country_code": "US",
            "telephone_number": "541-261-0223",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "DACARIE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-02",
        "last_updated": "2022-09-09",
        "certification_date": "2022-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "L11101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Skidmore PHD LLC
• Joseph A Roberts III
• Adrien Roberts
• Cheryl Jean Roberts, FNP
• Shanta Lorien Roberts, PHARMD
• Dominick Robertson, M.S.
• Jesse Robertson
• Mandy Robertson, CHW
• Michael Joseph Robertson II
• Marcelle Robicheau, RN

• Mental Health Counselor in Medford, OR
• Providers in Medford, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.