Provider Demographics
NPI:1639336522
Name:ROBLES, GERALDO JERRY III (CRC,LMHC)
Entity type:Individual
Prefix:MR
First Name:GERALDO
Middle Name:JERRY
Last Name:ROBLES
Suffix:III
Gender:M
Credentials:CRC,LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 KINGS HWY APT 6H
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1620
Mailing Address - Country:US
Mailing Address - Phone:718-219-8014
Mailing Address - Fax:
Practice Address - Street 1:2900 BEDFORD AVE
Practice Address - Street 2:PSYCHOLOGY DEPARTMENT
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-2850
Practice Address - Country:US
Practice Address - Phone:718-219-8014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCRC # 00088304225C00000X
NY004380101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health