Healthcare Provider Details

I. General information

NPI: 1255782967
Provider Name (Legal Business Name): MRS. ROBIN HANCOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 DELAWARE AVE
EGG HARBOR TOWNSHIP NJ
08234-9621
US

IV. Provider business mailing address

311 DELAWARE AVE
EGG HARBOR TOWNSHIP NJ
08234-9621
US

V. Phone/Fax

Practice location:
  • Phone: 609-214-9309
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number37AC00222100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00714700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: