MEDICARE: MRS. MARY EVELISSE ROBLES LMHC

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	017275	NY

General Provider Information

NPI Number	:	1558226837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY EVELISSE ROBLES LMHC

Provider Business Mailing Address
First Line	:	10 ROSENSTOCK RD
Second Line	:
City	:	ELLENVILLE
State	:	NY
Zip	:	12428-1820
Country	:	US
Telephone Number	:	718-213-0493
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 ROSENSTOCK RD
Second Line	:
City	:	ELLENVILLE
State	:	NY
Zip	:	12428-1820
Country	:	US
Telephone Number	:	718-213-0493
Fax Number	:

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

Provider Enumeration Date	:	12/18/2025
Last Update Date	:	12/18/2025

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