Provider Demographics
NPI:1821552605
Name:ROBLES-GIL, JUAN JOSE (LMHC)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:JOSE
Last Name:ROBLES-GIL
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 QUINCY ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-2801
Mailing Address - Country:US
Mailing Address - Phone:617-784-4246
Mailing Address - Fax:
Practice Address - Street 1:148 MADISON AVE FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6700
Practice Address - Country:US
Practice Address - Phone:917-216-7787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009307101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty