Provider Demographics
NPI:1669832937
Name:CARROLL-YENKO, ROBYN (MS, NCSP)
Entity type:Individual
Prefix:
First Name:ROBYN
Middle Name:
Last Name:CARROLL-YENKO
Suffix:
Gender:F
Credentials:MS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 561348
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32956
Mailing Address - Country:US
Mailing Address - Phone:407-412-4105
Mailing Address - Fax:
Practice Address - Street 1:107 OAKLEDGE DR
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5612
Practice Address - Country:US
Practice Address - Phone:407-412-4105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-01
Last Update Date:2020-01-13
Deactivation Date:2017-06-08
Deactivation Code:
Reactivation Date:2020-01-13
Provider Licenses
StateLicense IDTaxonomies
FLSS1222103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool