Provider Demographics
NPI:1407263999
Name:AVERY, ROBIN ANN (PHD)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:ANN
Last Name:AVERY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ROBIN
Other - Middle Name:A
Other - Last Name:AVERY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:9999 NE 2ND AVE
Mailing Address - Street 2:SUITE 209, E
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2352
Mailing Address - Country:US
Mailing Address - Phone:786-615-4758
Mailing Address - Fax:
Practice Address - Street 1:9999 NE 2ND AVE
Practice Address - Street 2:SUITE 209, E
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2352
Practice Address - Country:US
Practice Address - Phone:786-615-4758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8768103T00000X, 103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00000OtherDO NOT HAVE ANY NUMBER AT THIS TIME