Provider Demographics
NPI:1497995567
Name:ROBINSON, MARCELLA (LAC, LMT)
Entity Type:Individual
Prefix:MS
First Name:MARCELLA
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 GERALD DR APT F2
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-2923
Mailing Address - Country:US
Mailing Address - Phone:917-232-3949
Mailing Address - Fax:
Practice Address - Street 1:2 LAGRANGE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-8911
Practice Address - Country:US
Practice Address - Phone:917-232-3949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
FLAP2503171100000X
NY1418171100000X
FL52483172M00000X
NY011658172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1497995567Medicaid
FL050892600Medicaid
FL89368OtherBCBS
NY1497995567OtherBCBS
1497995567OtherBCBS
FL89368OtherBCBS
NY1497995567Medicare PIN
FL050892600Medicaid
NY1497995567Medicare Oscar/Certification
NY1497995567Medicaid