Provider Demographics
NPI:1720457138
Name:MACHATTIE, ROBIN JO (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:JO
Last Name:MACHATTIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:JO
Other - Last Name:HAMPEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33 CONNECTICUT AVE
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-3303
Mailing Address - Country:US
Mailing Address - Phone:518-786-4734
Mailing Address - Fax:
Practice Address - Street 1:1 BUFFINGTON ST
Practice Address - Street 2:BLDG 120
Practice Address - City:WATERVLIET
Practice Address - State:NY
Practice Address - Zip Code:12189-4000
Practice Address - Country:US
Practice Address - Phone:518-270-1510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082217-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical