Provider Demographics
NPI:1134216500
Name:ROBINSON, JESSICA DAWN (PHD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:DAWN
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 9TH ST
Mailing Address - Street 2:STE A
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014
Mailing Address - Country:US
Mailing Address - Phone:858-481-8847
Mailing Address - Fax:858-481-8249
Practice Address - Street 1:318 9TH ST
Practice Address - Street 2:STE A
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014
Practice Address - Country:US
Practice Address - Phone:858-481-8847
Practice Address - Fax:858-481-8249
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18805103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
32098OtherMHN
32098OtherMHN