Provider Demographics
NPI:1679381636
Name:ROBINSON, KERI RENNEE (MAED, BCBA, COBA)
Entity type:Individual
Prefix:MRS
First Name:KERI
Middle Name:RENNEE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MAED, BCBA, COBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VICTORY
Mailing Address - State:OH
Mailing Address - Zip Code:43340-8868
Mailing Address - Country:US
Mailing Address - Phone:937-441-6742
Mailing Address - Fax:
Practice Address - Street 1:361 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT VICTORY
Practice Address - State:OH
Practice Address - Zip Code:43340-8868
Practice Address - Country:US
Practice Address - Phone:937-441-6742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOBA.01090103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst