Provider Demographics
NPI:1144615758
Name:MANLEY, ROBYN FANTON
Entity Type:Individual
Prefix:MS
First Name:ROBYN
Middle Name:FANTON
Last Name:MANLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 VIRGINIA RD STE 204
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2769
Mailing Address - Country:US
Mailing Address - Phone:781-674-0000
Mailing Address - Fax:
Practice Address - Street 1:555 VIRGINIA RD STE 204
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2769
Practice Address - Country:US
Practice Address - Phone:781-674-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst