Healthcare Provider Details

I. General information

NPI: 1669832937
Provider Name (Legal Business Name): ROBYN CARROLL-YENKO M.S., NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date: 06/08/2017
Reactivation Date: 01/13/2020

III. Provider practice location address

107 OAKLEDGE DR
ROCKLEDGE FL
32955-5612
US

IV. Provider business mailing address

PO BOX 561348
ROCKLEDGE FL
32956
US

V. Phone/Fax

Practice location:
  • Phone: 407-412-4105
  • Fax:
Mailing address:
  • Phone: 407-412-4105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS1222
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: