MEDICARE: MR. JERROD HANDY-ROBINSON PSYD

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1821474206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JERROD HANDY-ROBINSON PSYD

Provider Business Mailing Address
First Line	:	812 W WAVELAND AVE APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-4386
Country	:	US
Telephone Number	:	570-947-8514
Fax Number	:

Provider Business Practice Location Address
First Line	:	812 W WAVELAND AVE APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-4386
Country	:	US
Telephone Number	:	570-947-8514
Fax Number	:

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

Provider Enumeration Date	:	08/07/2015
Last Update Date	:	09/29/2022

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