Provider Demographics
NPI:1598965931
Name:DRACH, ROBYN A (PHD, LP)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:A
Last Name:DRACH
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 CLIFF DRIVE, #104
Mailing Address - Street 2:2113 CLIFF DRIVE, #104
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122
Mailing Address - Country:US
Mailing Address - Phone:952-261-8441
Mailing Address - Fax:651-925-0338
Practice Address - Street 1:2113 CLIFF DRIVE, #104
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122
Practice Address - Country:US
Practice Address - Phone:952-261-8441
Practice Address - Fax:651-925-0338
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
MNLP4830103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist