Provider Demographics
NPI:1083676977
Name:ROBINSON, F CAL (PSYD)
Entity type:Individual
Prefix:
First Name:F
Middle Name:CAL
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2844 E LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62712-5531
Mailing Address - Country:US
Mailing Address - Phone:757-349-3525
Mailing Address - Fax:
Practice Address - Street 1:2844 E LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62712-5531
Practice Address - Country:US
Practice Address - Phone:757-349-3525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1075103TC0700X
IL071.004718103TC0700X
IL071004718103TC0700X
WI2606103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3A6187545Medicare PIN
R33571Medicare UPIN