Provider Demographics
NPI:1043314651
Name:DEGIOVINE-ROBINS, MARY (CRC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:DEGIOVINE-ROBINS
Suffix:
Gender:F
Credentials:CRC
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:MAJOWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:175 FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-3718
Mailing Address - Country:US
Mailing Address - Phone:631-489-8101
Mailing Address - Fax:
Practice Address - Street 1:175 FULTON AVE
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3718
Practice Address - Country:US
Practice Address - Phone:631-489-8101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health