Provider Demographics
NPI:1003857426
Name:ROBBINS, MARY JO (LMSW ACSW LMFT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JO
Last Name:ROBBINS
Suffix:
Gender:F
Credentials:LMSW ACSW LMFT
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:JO
Other - Last Name:DEMPSEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW ACSW LMFT
Mailing Address - Street 1:5124 BROOKWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:MONTAGUE
Mailing Address - State:MI
Mailing Address - Zip Code:49437-1001
Mailing Address - Country:US
Mailing Address - Phone:231-894-5011
Mailing Address - Fax:
Practice Address - Street 1:800 E ELLIS RD
Practice Address - Street 2:SUITE 221
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-5622
Practice Address - Country:US
Practice Address - Phone:231-722-8500
Practice Address - Fax:517-579-0272
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010338571041C0700X
MI4101005756106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008901560OtherBLUE CROSS BLUE SHIELD
263864000OtherMAGELLAN
263864000OtherMAGELLAN
P15237Medicare UPIN