1861553869 NPI number — MRS. MAUDE ANN ROBINSON LMHC CAP NCC MAC

Table of content: MRS. MAUDE ANN ROBINSON LMHC CAP NCC MAC (NPI 1861553869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861553869 NPI number — MRS. MAUDE ANN ROBINSON LMHC CAP NCC MAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBINSON
Provider First Name:
MAUDE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMHC CAP NCC MAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CURNUTTE
Provider Other First Name:
MAUDE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1861553869
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 KAY LARKIN DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALATKA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-329-3780
Provider Business Mailing Address Fax Number:
386-329-3786

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 KAY LARKIN DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALATKA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-329-3780
Provider Business Practice Location Address Fax Number:
386-329-3786
Provider Enumeration Date:
12/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: MH4184 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Z7914 . This is a "BC/BS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 762255400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 765585100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".