Provider Demographics
NPI:1811391147
Name:ROBLES, SALLY MARIA (PHD)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:MARIA
Last Name:ROBLES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:ROBLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:4213 248TH ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11363-1650
Mailing Address - Country:US
Mailing Address - Phone:917-613-6253
Mailing Address - Fax:
Practice Address - Street 1:4213 248TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11363-1650
Practice Address - Country:US
Practice Address - Phone:917-613-6253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68012934103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical