Provider Demographics
NPI:1477195386
Name:ROBALINO, MAYTE STEPHANIE
Entity Type:Individual
Prefix:
First Name:MAYTE
Middle Name:STEPHANIE
Last Name:ROBALINO
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 1:96 LOWER FISH ROCK RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2188
Mailing Address - Country:US
Mailing Address - Phone:203-721-3975
Mailing Address - Fax:
Practice Address - Street 1:96 DIKEMAN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06704-3905
Practice Address - Country:US
Practice Address - Phone:203-510-1002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0105001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty