Provider Demographics
NPI:1548795032
Name:ROBINSON, MAYA (MS, LPC, SAC-IT)
Entity Type:Individual
Prefix:MRS
First Name:MAYA
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MS, LPC, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2652 N 124TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1014
Mailing Address - Country:US
Mailing Address - Phone:414-803-1734
Mailing Address - Fax:
Practice Address - Street 1:2652 N 124TH ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1014
Practice Address - Country:US
Practice Address - Phone:414-803-1734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17788-130101YA0400X
WI6428-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)