Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | B1-0000804 | DE |
N | 103T00000X | Psychologist | B1-0000804 | DE |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | B10000804 | DE |
NPI | 1053546747 |
---|---|
Provider Name | Kristen Marie Robust |
First Address | Rockland, DE 19732-0191 |
Second Address | Seaford, DE 19973-1577 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2009 |
Last Update Date | 12/11/2012 |