Provider Demographics
NPI:1548827603
Name:ROBINSON, DORIS MARILYN (CSW)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:MARILYN
Last Name:ROBINSON
Suffix:
Gender:
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 N MARION ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84116-2645
Mailing Address - Country:US
Mailing Address - Phone:801-839-4007
Mailing Address - Fax:
Practice Address - Street 1:1050 E 3300 S STE 201
Practice Address - Street 2:
Practice Address - City:MILLCREEK
Practice Address - State:UT
Practice Address - Zip Code:84106-3995
Practice Address - Country:US
Practice Address - Phone:801-692-3531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14017186-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1548827603Medicaid