Provider Demographics
NPI:1346908712
Name:ROBINSON, RENEE R (CARE MANGER)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:R
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:CARE MANGER
Other - Prefix:MS
Other - First Name:RENEE
Other - Middle Name:R
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CASE MANAGER
Mailing Address - Street 1:830 E SAHARA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3009
Mailing Address - Country:US
Mailing Address - Phone:702-830-0240
Mailing Address - Fax:702-441-1966
Practice Address - Street 1:4880 W MONTARA CIR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5634
Practice Address - Country:US
Practice Address - Phone:702-830-0240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1104455476Medicaid