1962924456 NPI number — MS. ROBIN MARIE TAYLOR LCSW

Table of content: MS. ROBIN MARIE TAYLOR LCSW (NPI 1962924456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962924456 NPI number — MS. ROBIN MARIE TAYLOR LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLOR
Provider First Name:
ROBIN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AHLGREN
Provider Other First Name:
ROBIN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962924456
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3880 SOUTH WASHINGTON AVE
Provider Second Line Business Mailing Address:
SUITE 238
Provider Business Mailing Address City Name:
TITUSVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32780
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-735-8113
Provider Business Mailing Address Fax Number:
833-921-0180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3880 SOUTH WASHINGTON AVE
Provider Second Line Business Practice Location Address:
SUITE 238
Provider Business Practice Location Address City Name:
TITUSVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-735-8113
Provider Business Practice Location Address Fax Number:
833-921-0180
Provider Enumeration Date:
07/17/2017

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: 1041C0700X , with the licence number:  SW13070 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 023739200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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