Provider Demographics
NPI:1679673362
Name:SLOBODA-KOUSOULAS, ROBYN G (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROBYN
Middle Name:G
Last Name:SLOBODA-KOUSOULAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 WOLFE CIR
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2143
Mailing Address - Country:US
Mailing Address - Phone:845-735-4681
Mailing Address - Fax:845-735-4681
Practice Address - Street 1:8 WOLFE CIR
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2143
Practice Address - Country:US
Practice Address - Phone:845-735-4681
Practice Address - Fax:845-735-4681
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO116951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN14151Medicare ID - Type Unspecified
NYN15141Medicare PIN