Provider Demographics
NPI:1780220830
Name:ROBINSON, THEODORE R JR (MHW)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:R
Last Name:ROBINSON
Suffix:JR
Gender:M
Credentials:MHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 PATRICIA DR APT F
Mailing Address - Street 2:
Mailing Address - City:YEADON
Mailing Address - State:PA
Mailing Address - Zip Code:19050-4007
Mailing Address - Country:US
Mailing Address - Phone:267-784-8391
Mailing Address - Fax:
Practice Address - Street 1:3300 HENRY AVE STE 113
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19129-1146
Practice Address - Country:US
Practice Address - Phone:267-784-8391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor