Provider Demographics
NPI:1033962410
Name:BIRDSONG, ROBIN M (MA)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:M
Last Name:BIRDSONG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 355
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-0355
Mailing Address - Country:US
Mailing Address - Phone:646-801-7786
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 355
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-0355
Practice Address - Country:US
Practice Address - Phone:646-801-7786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18-P127782-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health