MEDICARE: MS. ROBYN WYNNE OLDS LCAT

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	101YM0800X	Mental Health Counselor	002132	NY

General Provider Information

NPI Number	:	1306351416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROBYN WYNNE OLDS LCAT

Provider Business Mailing Address
First Line	:	85 CLAY ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11222-1239
Country	:	US
Telephone Number	:	646-963-1169
Fax Number	:

Provider Business Practice Location Address
First Line	:	252 JAVA ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11222-5424
Country	:	US
Telephone Number	:	646-963-1169
Fax Number	:

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

Provider Enumeration Date	:	12/12/2017
Last Update Date	:	12/12/2017

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