Provider Demographics
NPI:1881916807
Name:ROBBINS, KELLY MARIE (L I S W)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:MARIE
Last Name:ROBBINS
Suffix:
Gender:F
Credentials:L I S W
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 46 BOX 667
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO DOWNS
Mailing Address - State:NM
Mailing Address - Zip Code:88346-9613
Mailing Address - Country:US
Mailing Address - Phone:575-378-8985
Mailing Address - Fax:
Practice Address - Street 1:232 E CIRCLE DR
Practice Address - Street 2:
Practice Address - City:RUIDOSO DOWNS
Practice Address - State:NM
Practice Address - Zip Code:88346-9545
Practice Address - Country:US
Practice Address - Phone:575-378-8985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-058431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical