Healthcare Provider Details

I. General information

NPI: 1023183860
Provider Name (Legal Business Name): JUDITH MARIE ROBINSON L.C.P.C. R.N.C.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 CHURCH ST SUITE 221
EVANSTON IL
60201-3875
US

IV. Provider business mailing address

1500 CHICAGO AVE
EVANSTON IL
60201-4428
US

V. Phone/Fax

Practice location:
  • Phone: 847-501-1013
  • Fax:
Mailing address:
  • Phone: 847-424-1236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180-002949
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number0041-306058
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: