Provider Demographics
NPI:1548856354
Name:ROBINSON, DEONDRA CHELYCE (BCABA)
Entity type:Individual
Prefix:
First Name:DEONDRA
Middle Name:CHELYCE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ASBURY PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-6346
Mailing Address - Country:US
Mailing Address - Phone:732-766-3679
Mailing Address - Fax:
Practice Address - Street 1:78 JOHN MILLER WAY STE 300
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-6531
Practice Address - Country:US
Practice Address - Phone:855-500-3848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0-20-11641103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst