Provider Demographics
NPI:1598776759
Name:HOBURG, ROBIN R (PHD)
Entity Type:Individual
Prefix:MISS
First Name:ROBIN
Middle Name:R
Last Name:HOBURG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MISS
Other - First Name:ROBIN
Other - Middle Name:R
Other - Last Name:HOBURG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYCHOLOGIST
Mailing Address - Street 1:PO BOX 763
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-0763
Mailing Address - Country:US
Mailing Address - Phone:860-870-1144
Mailing Address - Fax:860-870-1155
Practice Address - Street 1:593 OLD POST RD
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-2828
Practice Address - Country:US
Practice Address - Phone:860-870-1144
Practice Address - Fax:860-870-1155
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002489103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060002489CT01OtherBLUE SHIELD PROVIDER NUMB
CT680001730Medicare ID - Type UnspecifiedPROVIDER NUMBER