Provider Demographics
NPI:1467438184
Name:MEHLENBECK, ROBYN S (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBYN
Middle Name:S
Last Name:MEHLENBECK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 EDDY ST
Mailing Address - Street 2:APC 970
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:401-444-8638
Mailing Address - Fax:401-444-8742
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:APC 970
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-8638
Practice Address - Fax:401-444-8742
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00682103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P03891Medicare UPIN
007008219Medicare ID - Type Unspecified