Provider Demographics
NPI:1144229675
Name:ROBINSON, MINDI L (LCSW)
Entity Type:Individual
Prefix:
First Name:MINDI
Middle Name:L
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 Q ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-4718
Mailing Address - Country:US
Mailing Address - Phone:812-279-4673
Mailing Address - Fax:812-279-4672
Practice Address - Street 1:2325 Q ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-4718
Practice Address - Country:US
Practice Address - Phone:812-279-4673
Practice Address - Fax:812-279-4672
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN340004943A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000362287OtherANTHEM BCBS
IN225000Medicare PIN
INQ39733Medicare UPIN