Provider Demographics
NPI:1104996669
Name:ROBIE, MARILYN B (PHD)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:B
Last Name:ROBIE
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 1:637 SAYRE AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-2317
Mailing Address - Country:US
Mailing Address - Phone:859-225-1476
Mailing Address - Fax:859-259-1301
Practice Address - Street 1:637 SAYRE AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2317
Practice Address - Country:US
Practice Address - Phone:859-225-1476
Practice Address - Fax:859-259-1301
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0607103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000042999OtherANTHEM
KY044249OtherVALUE OPTIONS
KY1187382OtherCHA
KY61-42546OtherUBH
KY4212556OtherAETNA
KY1187382OtherCHA
KYS35825Medicare UPIN