Provider Demographics
NPI:1083843106
Name:ROBBEN, MIA KIM (PHD)
Entity Type:Individual
Prefix:DR
First Name:MIA
Middle Name:KIM
Last Name:ROBBEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JANE
Other - Middle Name:MIA
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1400 E WEST HWY
Mailing Address - Street 2:APT # 915
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3230
Mailing Address - Country:US
Mailing Address - Phone:301-254-8397
Mailing Address - Fax:
Practice Address - Street 1:620 MICHIGAN AVE NE
Practice Address - Street 2:127 O'BOYLE HALL
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20064-0001
Practice Address - Country:US
Practice Address - Phone:202-319-4340
Practice Address - Fax:202-319-5570
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000530103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist