Healthcare Provider Details

I. General information

NPI: 1598135048
Provider Name (Legal Business Name): JAMAL CORNELL ROBINSON MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2015
Last Update Date: 09/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 BRIDGE ST BLDG 5B-132
PHILADELPHIA PA
19137-2307
US

IV. Provider business mailing address

2275 BRIDGE ST BLDG 5B-132
PHILADELPHIA PA
19137-2307
US

V. Phone/Fax

Practice location:
  • Phone: 215-772-0101
  • Fax: 215-772-0303
Mailing address:
  • Phone: 215-772-0101
  • Fax: 215-772-0303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: