Provider Demographics
NPI:1376688812
Name:ROBINSON, GINA MICHELLE (LCSW C)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MICHELLE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:LCSW C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3362 NORTH CHATHAM RD
Mailing Address - Street 2:APT # I
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042
Mailing Address - Country:US
Mailing Address - Phone:410-465-1360
Mailing Address - Fax:
Practice Address - Street 1:10630 LITTLE PATUXENT PKWY STE 475
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-6228
Practice Address - Country:US
Practice Address - Phone:443-574-4295
Practice Address - Fax:443-574-6515
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13046104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2144939OtherMAMSI OPTIMUM CHOICE MDIP
MDH1240024OtherCAREFIRST BLUECHOICE
835749000OtherMAGELLAN BEHAVIORAL HEALT
MD88497901OtherCAREFIRST BCBS
260193OtherKAISER PERMANENTE
566863OtherVALUE OPTIONS
9419976OtherPRIVATE HEALTHCARE SYSTEM
376856OtherMANAGED HEALTH NETWORK
7162763OtherAETNA US HEALTHCARE