Provider Demographics
NPI:1134345572
Name:STORM, ROBIN (MA)
Entity type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:
Last Name:STORM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4711 N 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-3478
Mailing Address - Country:US
Mailing Address - Phone:602-242-2442
Mailing Address - Fax:602-242-2514
Practice Address - Street 1:4711 N 23RD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-3478
Practice Address - Country:US
Practice Address - Phone:602-242-2442
Practice Address - Fax:602-242-2514
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool