Healthcare Provider Details

I. General information

NPI: 1225505530
Provider Name (Legal Business Name): PETA-GAY ANDRENE ROBINSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2018
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 E 149TH ST
BRONX NY
10451-5625
US

IV. Provider business mailing address

22538 MURDOCK AVE
QUEENS VILLAGE NY
11429-2729
US

V. Phone/Fax

Practice location:
  • Phone: 718-769-2698
  • Fax:
Mailing address:
  • Phone: 347-712-9038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number102251-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: