Provider Demographics
NPI:1356098149
Name:ROBINSON, TANESHA
Entity Type:Individual
Prefix:
First Name:TANESHA
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 SAINT GEORGES AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-3427
Mailing Address - Country:US
Mailing Address - Phone:908-388-1716
Mailing Address - Fax:856-212-1214
Practice Address - Street 1:1503 SAINT GEORGES AVE STE 106
Practice Address - Street 2:
Practice Address - City:COLONIA
Practice Address - State:NJ
Practice Address - Zip Code:07067-3427
Practice Address - Country:US
Practice Address - Phone:908-388-1716
Practice Address - Fax:856-212-1214
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37LC00260400OtherSTATE LICENSE