Provider Demographics
NPI:1356881114
Name:ROBINSON, RUDIE (LCPC-C)
Entity type:Individual
Prefix:
First Name:RUDIE
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-7144
Mailing Address - Country:US
Mailing Address - Phone:207-945-4240
Mailing Address - Fax:207-990-3660
Practice Address - Street 1:40 SUMMER ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-7144
Practice Address - Country:US
Practice Address - Phone:207-945-4240
Practice Address - Fax:207-990-3660
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4858101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health