Provider Demographics
NPI:1487938015
Name:TRENCHER JACOB, ROBIN SUSANNE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:SUSANNE
Last Name:TRENCHER JACOB
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:MS
Other - First Name:ROBIN
Other - Middle Name:SUSANNE
Other - Last Name:TRENCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:129 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:VOORHEESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12186-9726
Mailing Address - Country:US
Mailing Address - Phone:518-439-0381
Mailing Address - Fax:518-765-3842
Practice Address - Street 1:129 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:VOORHEESVILLE
Practice Address - State:NY
Practice Address - Zip Code:12186-9726
Practice Address - Country:US
Practice Address - Phone:518-439-0381
Practice Address - Fax:518-765-3842
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030729104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker