Provider Demographics
NPI:1114160033
Name:ROBINSON, GRACE S (MA, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:S
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MA, LCSW
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 887
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-0887
Mailing Address - Country:US
Mailing Address - Phone:847-838-9904
Mailing Address - Fax:847-838-9907
Practice Address - Street 1:800 MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-1542
Practice Address - Country:US
Practice Address - Phone:847-838-9904
Practice Address - Fax:847-838-9907
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.009983101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor