Provider Demographics
NPI:1396149415
Name:ROBINSON, MALLORY E (MA, LPC, BCBS, LBS)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:E
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MA, LPC, BCBS, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W MILL ST
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-1627
Mailing Address - Country:US
Mailing Address - Phone:570-765-1825
Mailing Address - Fax:
Practice Address - Street 1:45 US -11
Practice Address - Street 2:
Practice Address - City:SHAMOKIN DAM
Practice Address - State:PA
Practice Address - Zip Code:17876
Practice Address - Country:US
Practice Address - Phone:570-931-3849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst