Provider Demographics
NPI:1053144642
Name:SARKISSIAN, ROBIN (LICSWA)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:
Last Name:SARKISSIAN
Suffix:
Gender:
Credentials:LICSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4521 S 19TH ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-7171
Mailing Address - Country:US
Mailing Address - Phone:505-501-5125
Mailing Address - Fax:
Practice Address - Street 1:4521 S 19TH ST
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-7171
Practice Address - Country:US
Practice Address - Phone:505-501-5125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 104100000X
WASC615915731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical