Healthcare Provider Details

I. General information

NPI: 1407563596
Provider Name (Legal Business Name): KIESHA MARIE ROBINSON BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

981 ORELLANA RD
ST AUGUSTINE FL
32084-2077
US

IV. Provider business mailing address

981 ORELLANA RD
ST AUGUSTINE FL
32084-2077
US

V. Phone/Fax

Practice location:
  • Phone: 904-788-5535
  • Fax:
Mailing address:
  • Phone: 904-788-5535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA2164
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133004665
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number690
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: