Provider Demographics
NPI:1174013627
Name:TEBBETTS, ROBYN (LICSW)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:
Last Name:TEBBETTS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:ROBYN
Other - Middle Name:
Other - Last Name:TEBBETTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ROBYN YURCEK
Mailing Address - Street 1:92 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4525
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:92 ADAMS ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4525
Practice Address - Country:US
Practice Address - Phone:802-322-3555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.011377391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical