Healthcare Provider Details

I. General information

NPI: 1497159651
Provider Name (Legal Business Name): ANDREA BETH ROBINSON LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 36TH ST SE
GRAND RAPIDS MI
49512-2810
US

IV. Provider business mailing address

1212 THOMAS ST SE
GRAND RAPIDS MI
49506-2650
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-2110
  • Fax:
Mailing address:
  • Phone: 616-490-3360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801090957
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: