Basic Information
| Provider Information | |||||||||
| NPI: | 1659656510 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBINS | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | CAROL | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.A. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ROBINS | ||||||||
| OtherFirstName: | ELIZABETH | ||||||||
| OtherMiddleName: | CAROL | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3326 S CANFIELD AVE APT 2 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900342922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479890387 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13130 BURBANK BLVD | ||||||||
| Address2: | |||||||||
| City: | SHERMAN OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914016037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187810360 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2011 | ||||||||
| LastUpdateDate: | 03/25/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 84333 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.