Basic Information
| Provider Information | |||||||||
| NPI: | 1720245764 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBINSON | ||||||||
| FirstName: | ALBERT | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 178-00 LINDEN BLVD | ||||||||
| Address2: | E WING ROOM 231 | ||||||||
| City: | ST. ALBANS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185261000 | ||||||||
| FaxNumber: | 7182988529 | ||||||||
| Practice Location | |||||||||
| Address1: | 17800 LINDEN BLVD | ||||||||
| Address2: | E WING 2ND FLOOR ROOM 231 | ||||||||
| City: | ST. ALBANS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114250000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185261000 | ||||||||
| FaxNumber: | 7182988529 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2008 | ||||||||
| LastUpdateDate: | 02/04/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 094217-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 00244019 | 05 | NY | MEDICAID |