MEDICARE: MS. MARY JO ROBBINS LMSW ACSW LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801033857	MI
2	106H00000X	Marriage & Family Therapist	4101005756	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8008901560	OTHER	MI	BLUE CROSS BLUE SHIELD
2	263864000	OTHER		MAGELLAN

General Provider Information

NPI Number	:	1003857426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY JO ROBBINS LMSW ACSW LMFT

Provider Business Mailing Address
First Line	:	5124 BROOKWOOD CIR
Second Line	:
City	:	MONTAGUE
State	:	MI
Zip	:	49437-1001
Country	:	US
Telephone Number	:	231-894-5011
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 E ELLIS RD
Second Line	:	SUITE 221
City	:	NORTON SHORES
State	:	MI
Zip	:	49441-5622
Country	:	US
Telephone Number	:	231-722-8500
Fax Number	:	517-579-0272

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	10/28/2012

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