Provider Demographics
NPI:1578641114
Name:ROBINSON, ANN M (MA)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:M
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46989-9132
Mailing Address - Country:US
Mailing Address - Phone:765-998-0763
Mailing Address - Fax:765-288-4044
Practice Address - Street 1:4607 N WHEELING AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-1220
Practice Address - Country:US
Practice Address - Phone:765-288-1110
Practice Address - Fax:765-288-4044
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001588A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000316085OtherANTHEM BCBS
IN210690Medicare ID - Type Unspecified