Doctor Name: | ROBIN L FORMICK |
NPI Number: | 1104044585 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | E.0004226 |
License Number: | E0004226 |
Business Practice Address: | 520 N Chestnut St Ravenna, OH - 442662218 |
Business Phone Number: | 3302965552 |
Business Fax Number: | |
Mailing Address: | 4070 Sabin Dr, ROOTSTOWN |
State: | OH |
Postal Code: | 442729617 |
Phone Number: | 3303250545 |
Fax Number: | |
NPI Enumeration Date: | 04/23/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | E0004226 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |