Provider Demographics
NPI:1578765707
Name:ROBBINS, MIRANDA WALKER (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:WALKER
Last Name:ROBBINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:
Other - Last Name:ROBBINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:3550 COLLEGE AVENUE
Mailing Address - Street 2:SUITE # C
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-5008
Mailing Address - Country:US
Mailing Address - Phone:618-463-5927
Mailing Address - Fax:618-463-5965
Practice Address - Street 1:3550 COLLEGE AVENUE
Practice Address - Street 2:SUITE # C
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-5008
Practice Address - Country:US
Practice Address - Phone:618-463-5927
Practice Address - Fax:618-463-5965
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical