Provider Demographics
NPI:1639182728
Name:ROBINSON, THERESA C (PSY D)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:C
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 STANNARD AVE
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-4430
Mailing Address - Country:US
Mailing Address - Phone:203-488-1969
Mailing Address - Fax:
Practice Address - Street 1:44 STANNARD AVE
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-4430
Practice Address - Country:US
Practice Address - Phone:203-488-1969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002668103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT11447185OtherC.A.Q.H.
CT001239OtherL.C.S.W.
CT002668OtherPSYCHOLOGIST
CT001239OtherL.C.S.W.