Provider Demographics
NPI:1760538243
Name:ROBINSON, MELISSA ANN (LISW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7519 GOSHAWK AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-3573
Mailing Address - Country:US
Mailing Address - Phone:505-890-6539
Mailing Address - Fax:
Practice Address - Street 1:1695 CARRERA DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1648
Practice Address - Country:US
Practice Address - Phone:214-705-0874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-062811041C0700X
TX517281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX51728OtherTEXAS BARD OF SOCIAL WORK EXAMINERS