Provider Demographics
NPI:1043833627
Name:SALDIVAR, ROBIN ELAINE
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:ELAINE
Last Name:SALDIVAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 BIERCE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45403-2657
Mailing Address - Country:US
Mailing Address - Phone:937-207-9630
Mailing Address - Fax:
Practice Address - Street 1:326 BIERCE AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45403-2657
Practice Address - Country:US
Practice Address - Phone:937-207-9630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-18
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0003776-SUPV101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0404269Medicaid