Healthcare Provider Details

I. General information

NPI: 1063330751
Provider Name (Legal Business Name): MATTHEW ROBBINS LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 ROUTE 70 E BLDG A-100
MARLTON NJ
08053-2341
US

IV. Provider business mailing address

103 CHARLANN CIR
CHERRY HILL NJ
08003-2906
US

V. Phone/Fax

Practice location:
  • Phone: 856-983-3900
  • Fax:
Mailing address:
  • Phone: 856-745-9489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00715300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: