Provider Demographics
NPI:1073671178
Name:ROBIN, ANNE M (MFT)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:ROBIN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23050 FREDIANI WAY
Mailing Address - Street 2:
Mailing Address - City:TWAIN HARTE
Mailing Address - State:CA
Mailing Address - Zip Code:95383-9516
Mailing Address - Country:US
Mailing Address - Phone:209-584-5987
Mailing Address - Fax:
Practice Address - Street 1:1601 YOSEMITE BLVD STE A
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-2800
Practice Address - Country:US
Practice Address - Phone:209-341-1824
Practice Address - Fax:209-523-1296
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC22445106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA106HOOOOOXOtherMARRIAGE AND FAMILY THERA