Provider Demographics
NPI:1467283861
Name:ROBINSON, ANTONELL
Entity type:Individual
Prefix:
First Name:ANTONELL
Middle Name:
Last Name:ROBINSON
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 1:7949 RIDGE AVE APT B3
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-3014
Mailing Address - Country:US
Mailing Address - Phone:267-414-8478
Mailing Address - Fax:
Practice Address - Street 1:7949 RIDGE AVE APT B3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-3014
Practice Address - Country:US
Practice Address - Phone:267-414-8478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health