Provider Demographics
NPI:1023394137
Name:ST. VICTOR, ROBINSON
Entity Type:Individual
Prefix:MR
First Name:ROBINSON
Middle Name:
Last Name:ST. VICTOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 CLASSON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-6102
Mailing Address - Country:US
Mailing Address - Phone:718-230-5100
Mailing Address - Fax:
Practice Address - Street 1:901 WASHINGTON AVE
Practice Address - Street 2:APT. 4-F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-1041
Practice Address - Country:US
Practice Address - Phone:646-752-2684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7577622101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health