Healthcare Provider Details

I. General information

NPI: 1083676977
Provider Name (Legal Business Name): F CAL ROBINSON PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2844 E LAKE SHORE DR
SPRINGFIELD IL
62712-5531
US

IV. Provider business mailing address

2844 E LAKE SHORE DR
SPRINGFIELD IL
62712-5531
US

V. Phone/Fax

Practice location:
  • Phone: 757-349-3525
  • Fax:
Mailing address:
  • Phone: 757-349-3525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1075
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.004718
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071004718
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2606
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: