Provider Demographics
NPI:1225129885
Name:ROBIN, JOAN CAROLYN (MA LMHC CRC LRC CH)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:CAROLYN
Last Name:ROBIN
Suffix:
Gender:F
Credentials:MA LMHC CRC LRC CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 MENDON ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSTONE
Mailing Address - State:MA
Mailing Address - Zip Code:01504
Mailing Address - Country:US
Mailing Address - Phone:508-883-4673
Mailing Address - Fax:508-883-0401
Practice Address - Street 1:61 MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACKSTONE
Practice Address - State:MA
Practice Address - Zip Code:01504
Practice Address - Country:US
Practice Address - Phone:508-883-4673
Practice Address - Fax:508-883-0401
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA31225C00000X
MA592101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2205191OtherCIGNA
MA776776000OtherMAGELLAN
118204OtherVALUE OPTIONS
118204OtherTRI CARE
MA180909OtherMHN
MALM0025OtherBCBS
MA1895109Medicaid