Provider Demographics
NPI:1598835621
Name:ROBINSON, DENISE RENEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:RENEE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 SQUIRREL RUN
Mailing Address - Street 2:
Mailing Address - City:CLARKS GREEN
Mailing Address - State:PA
Mailing Address - Zip Code:18411-8996
Mailing Address - Country:US
Mailing Address - Phone:570-587-7077
Mailing Address - Fax:
Practice Address - Street 1:120 N ABINGTON RD
Practice Address - Street 2:
Practice Address - City:CLARKS GREEN
Practice Address - State:PA
Practice Address - Zip Code:18411-2541
Practice Address - Country:US
Practice Address - Phone:570-586-4343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007171L103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent