Provider Demographics
NPI:1265144034
Name:ROBINSON-PEREZ, ADA (PHD)
Entity type:Individual
Prefix:
First Name:ADA
Middle Name:
Last Name:ROBINSON-PEREZ
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 1:717 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-1625
Mailing Address - Country:US
Mailing Address - Phone:607-742-0762
Mailing Address - Fax:
Practice Address - Street 1:3001 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760-5843
Practice Address - Country:US
Practice Address - Phone:607-754-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-23
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06858104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker