Provider Demographics
NPI:1902963002
Name:SMITH, ROBIN ROBBINS (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:ROBBINS
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 KITCHEN LN
Mailing Address - Street 2:
Mailing Address - City:ECRU
Mailing Address - State:MS
Mailing Address - Zip Code:38841-5502
Mailing Address - Country:US
Mailing Address - Phone:662-321-9145
Mailing Address - Fax:662-488-9154
Practice Address - Street 1:356A EAST OXFORD ST.
Practice Address - Street 2:
Practice Address - City:PONTOTOC
Practice Address - State:MS
Practice Address - Zip Code:38863
Practice Address - Country:US
Practice Address - Phone:662-321-9145
Practice Address - Fax:662-488-9154
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC20451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00123959Medicaid