Provider Demographics
NPI:1366055592
Name:SIEBOLD, ROBIN
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:
Last Name:SIEBOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 951338
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32795-1338
Mailing Address - Country:US
Mailing Address - Phone:407-765-9379
Mailing Address - Fax:
Practice Address - Street 1:801 INTERNATIONAL PKWY STE 500
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4763
Practice Address - Country:US
Practice Address - Phone:407-765-9379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3038101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health