MEDICARE: MRS. ROBIN LEE JOELEEN LA PORT MSED

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

General Provider Information

NPI Number	:	1730142308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROBIN LEE JOELEEN LA PORT MSED

Provider Business Mailing Address
First Line	:	PO BOX 554
Second Line	:
City	:	BROADALBIN
State	:	NY
Zip	:	12025-0554
Country	:	US
Telephone Number	:	518-725-4310
Fax Number	:	518-725-2556

Provider Business Practice Location Address
First Line	:	11-21 BROADWAY ST
Second Line	:
City	:	GLOVERSVILLE
State	:	NY
Zip	:	12078-3968
Country	:	US
Telephone Number	:	518-725-4310
Fax Number	:	518-725-2556

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	07/08/2007

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