Provider Demographics
NPI:1033159801
Name:ALTBRANDT, ROBINA (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBINA
Middle Name:
Last Name:ALTBRANDT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-6217
Mailing Address - Country:US
Mailing Address - Phone:203-640-6564
Mailing Address - Fax:
Practice Address - Street 1:441 ORANGE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-6217
Practice Address - Country:US
Practice Address - Phone:203-640-6564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0041811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004039244Medicaid
CT800001942Medicare ID - Type UnspecifiedMEDICARE PROVIDER