Provider Demographics
NPI:1760697346
Name:ROBINSON-VINE, MARY HELEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY HELEN
Middle Name:
Last Name:ROBINSON-VINE
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 1:225 ASHBOURNE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-1703
Mailing Address - Country:US
Mailing Address - Phone:585-442-8698
Mailing Address - Fax:
Practice Address - Street 1:325 PARK AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-2700
Practice Address - Country:US
Practice Address - Phone:585-442-4030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR049782-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010049782OtherEXCELLUS
NYCC2628Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER