Provider Demographics
NPI:1831239797
Name:ROBINSON, JANE A (PHD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:A
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 RHODE ISLAND ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48203-3356
Mailing Address - Country:US
Mailing Address - Phone:313-865-4129
Mailing Address - Fax:313-865-4129
Practice Address - Street 1:3011 W GRAND BLVD STE 418
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3011
Practice Address - Country:US
Practice Address - Phone:313-875-4433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301000592103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIR67477Medicare UPIN