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General NPI Number Information
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NPI Number | 1497386411
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Entity Type | Organization
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Legal Business Name | SALLY ROBLES
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Dates
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Enumeration Date | 01/29/2020
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Last Update Date | 01/29/2020
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Provider Practice Location Address
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Address Line | 7819 MYRTLE AVE
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City | GLENDALE
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State | NY
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Zip | 11385-7439
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Country | US
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Telephone | 917-485-2730
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Fax |
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Provider Business Mailing Address
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Address Line | 8320 98TH ST APT 3U
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City | WOODHAVEN
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State | NY
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Zip | 11421-1633
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER, PSYCHOLOGIST
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Name | SALLY ROBLES
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Credential |
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Telephone | 917-485-2730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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