Provider Demographics
NPI:1487945010
Name:CANCEL, ROBINSON RUBEN
Entity type:Individual
Prefix:MR
First Name:ROBINSON
Middle Name:RUBEN
Last Name:CANCEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2097 SW TRENTON LN
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-4322
Mailing Address - Country:US
Mailing Address - Phone:772-335-0713
Mailing Address - Fax:
Practice Address - Street 1:2097 SW TRENTON LN
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-4322
Practice Address - Country:US
Practice Address - Phone:772-335-0713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-01
Last Update Date:2011-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor