Provider Demographics
NPI:1194115873
Name:PETERNELL, ROBIN Y (LMFT)
Entity type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:Y
Last Name:PETERNELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 ABERDEEN ST NE STE 100
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-4810
Mailing Address - Country:US
Mailing Address - Phone:763-270-0054
Mailing Address - Fax:
Practice Address - Street 1:11800 ABERDEEN ST NE STE 100
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-4810
Practice Address - Country:US
Practice Address - Phone:763-270-0054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2019-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3685106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist