Provider Demographics
NPI:1053078477
Name:ROBIN PETERSON PSY D LLC
Entity Type:Organization
Organization Name:ROBIN PETERSON PSY D LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:616-920-0479
Mailing Address - Street 1:1035 LINCOLN RD STE 202
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4149
Mailing Address - Country:US
Mailing Address - Phone:563-355-4879
Mailing Address - Fax:
Practice Address - Street 1:1035 LINCOLN RD STE 202
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-4149
Practice Address - Country:US
Practice Address - Phone:563-355-4879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-19
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty