Provider Demographics
NPI:1790900751
Name:ROBINSON, SHIRLEY R (LCSW)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:R
Last Name:ROBINSON
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 1:24724 W EAMES ST
Mailing Address - Street 2:ROUTE 6
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-5446
Mailing Address - Country:US
Mailing Address - Phone:181-592-2228
Mailing Address - Fax:
Practice Address - Street 1:24724 W EAMES ST
Practice Address - Street 2:ROUTE 6
Practice Address - City:CHANNAHON
Practice Address - State:IL
Practice Address - Zip Code:60410-5446
Practice Address - Country:US
Practice Address - Phone:181-592-2228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9299530OtherBLUECROSSBLUESHIELD
IL210412Medicare PIN