Provider Demographics
NPI:1790061190
Name:DEATRICH, ROBIN ELIZABETH (LMSW, CH)
Entity Type:Individual
Prefix:MISS
First Name:ROBIN
Middle Name:ELIZABETH
Last Name:DEATRICH
Suffix:
Gender:F
Credentials:LMSW, CH
Other - Prefix:MRS
Other - First Name:ROBIN
Other - Middle Name:ELIZABETH
Other - Last Name:ABRAMOWITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:88 LITTLEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:ME
Mailing Address - Zip Code:04250-6009
Mailing Address - Country:US
Mailing Address - Phone:207-740-7477
Mailing Address - Fax:
Practice Address - Street 1:22 FARWELL ST
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:ME
Practice Address - Zip Code:04250-6824
Practice Address - Country:US
Practice Address - Phone:207-353-8118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-30
Last Update Date:2011-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELM128401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical