Provider Demographics
NPI:1528587771
Name:POOLE, ROBIN JANINE
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:JANINE
Last Name:POOLE
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 1:1155 S SEMORAN BLVD STE 1150
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-5505
Mailing Address - Country:US
Mailing Address - Phone:407-678-9800
Mailing Address - Fax:
Practice Address - Street 1:1155 S SEMORAN BLVD STE 1150
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-5505
Practice Address - Country:US
Practice Address - Phone:407-678-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH15689101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1457515934Medicaid