Provider Demographics
NPI:1548254386
Name:MUSTAIN, ROBIN RAY (MSW)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:RAY
Last Name:MUSTAIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13100 DEER PATH LN
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-6321
Mailing Address - Country:US
Mailing Address - Phone:301-528-0652
Mailing Address - Fax:
Practice Address - Street 1:4400 E WEST HWY
Practice Address - Street 2:SUITE 720
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4524
Practice Address - Country:US
Practice Address - Phone:301-652-3744
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD057521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
120306Medicare ID - Type Unspecified