Provider Demographics
NPI:1679874374
Name:DENICOLA, ROBIN DEE (MS)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:DEE
Last Name:DENICOLA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 E NEW HAVEN AVE STE 316
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-5417
Mailing Address - Country:US
Mailing Address - Phone:321-557-1141
Mailing Address - Fax:
Practice Address - Street 1:927 E NEW HAVEN AVE STE 316
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5417
Practice Address - Country:US
Practice Address - Phone:321-557-1141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2010-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4750 (CAP)101YA0400X
FL703172 (IC&RC)101YA0400X
FLSAP-DOT APPROVED101YA0400X
FL1-01-0508103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)