Provider Demographics
NPI:1336728377
Name:ROBINSON, JENNAVIEVE D (BA, MED)
Entity type:Individual
Prefix:
First Name:JENNAVIEVE
Middle Name:D
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:BA, MED
Other - Prefix:
Other - First Name:JENNAVIEVE
Other - Middle Name:D
Other - Last Name:ABNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, MED
Mailing Address - Street 1:39201 STATE ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1437
Mailing Address - Country:US
Mailing Address - Phone:866-206-2008
Mailing Address - Fax:
Practice Address - Street 1:39201 STATE ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1437
Practice Address - Country:US
Practice Address - Phone:866-206-2008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-06
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CA106S00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician