Provider Demographics
NPI:1639365604
Name:ROBINSON, MARY ANN (PHD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1543 GREEN OAK PL
Mailing Address - Street 2:STE.101
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2007
Mailing Address - Country:US
Mailing Address - Phone:281-852-3828
Mailing Address - Fax:
Practice Address - Street 1:1543 GREEN OAK PL
Practice Address - Street 2:STE.101
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2007
Practice Address - Country:US
Practice Address - Phone:281-852-3828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-4572103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00596PMedicare PIN