Provider Demographics
NPI:1306351416
Name:OLDS, ROBYN WYNNE (LCAT)
Entity type:Individual
Prefix:MS
First Name:ROBYN
Middle Name:WYNNE
Last Name:OLDS
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-1239
Mailing Address - Country:US
Mailing Address - Phone:646-963-1169
Mailing Address - Fax:
Practice Address - Street 1:252 JAVA ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-5424
Practice Address - Country:US
Practice Address - Phone:646-963-1169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002132101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health