Provider Demographics
NPI:1194032292
Name:JENNIE L. ROBB, PH.D., PLLC
Entity Type:Organization
Organization Name:JENNIE L. ROBB, PH.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROBB
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:941-320-6320
Mailing Address - Street 1:9070 58TH DR E STE 102
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-6110
Mailing Address - Country:US
Mailing Address - Phone:941-320-6320
Mailing Address - Fax:941-753-5969
Practice Address - Street 1:9070 58TH DR E STE 102
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-6110
Practice Address - Country:US
Practice Address - Phone:941-320-6320
Practice Address - Fax:941-753-5969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6351103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty