Healthcare Provider Details

I. General information

NPI: 1699977033
Provider Name (Legal Business Name): DIMITRA ROBOKOS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 PELHAM PKWY SOUTH
BRONX NY
10461
US

IV. Provider business mailing address

1410 PELHAM PKWY SOUTH
BRONX NY
10461
US

V. Phone/Fax

Practice location:
  • Phone: 718-430-8600
  • Fax: 718-892-2296
Mailing address:
  • Phone: 718-430-8600
  • Fax: 718-892-2296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001328
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0179861
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number017986
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: