Basic Information
| Provider Information | |||||||||
| NPI: | 1477011005 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBINSON | ||||||||
| FirstName: | SHANTEL | ||||||||
| MiddleName: | |||||||||
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| Credential: | LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 434 LINCOLN AVE APT B8 | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070502230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734747698 | ||||||||
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| Practice Location | |||||||||
| Address1: | 151 KNOLLCROFT RD | ||||||||
| Address2: | |||||||||
| City: | LYONS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079395001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9086470180 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2019 | ||||||||
| LastUpdateDate: | 03/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 44SL06238900 | NJ | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.