Provider Demographics
NPI:1619063377
Name:ROBINSON, MARS RAY (PSYD,MA, LMFT)
Entity Type:Individual
Prefix:
First Name:MARS
Middle Name:RAY
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:PSYD,MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 MOLLY LN
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-4519
Mailing Address - Country:US
Mailing Address - Phone:563-343-4228
Mailing Address - Fax:
Practice Address - Street 1:3406 MOLLY LN
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-4519
Practice Address - Country:US
Practice Address - Phone:563-343-4228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00192106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0283507Medicaid
IAI8118Medicare ID - Type Unspecified