Provider Demographics
NPI:1972616027
Name:ROBINSON, LAURA FAITH (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:FAITH
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2774
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33468-2774
Mailing Address - Country:US
Mailing Address - Phone:561-351-8766
Mailing Address - Fax:
Practice Address - Street 1:900 S US HIGHWAY 1
Practice Address - Street 2:SUITE 101
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-6459
Practice Address - Country:US
Practice Address - Phone:561-351-8766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5424103TC0700X, 103T00000X
NY012418103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73119Medicare ID - Type Unspecified