Provider Demographics
NPI:1225294234
Name:POPE SANTA TERESA, ROBIN CAROL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:CAROL
Last Name:POPE SANTA TERESA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:CAROL
Other - Last Name:POPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCP
Mailing Address - Street 1:3934 NORTH DIXIE HIGHWAY SUITE 210
Mailing Address - Street 2:VA HEALTHCARE SHIVELY
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216
Mailing Address - Country:US
Mailing Address - Phone:502-827-6207
Mailing Address - Fax:502-449-1931
Practice Address - Street 1:3934 NORTH DIXIE HIGHWAY
Practice Address - Street 2:SUITE 210
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216
Practice Address - Country:US
Practice Address - Phone:502-827-6207
Practice Address - Fax:502-449-1931
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1131103TC0700X
CO008595103TH0004X
CO0352018103TS0200X
NM220680103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool