Provider Demographics
NPI:1003185216
Name:BURCH, ROBERT STANLEY (CASAC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:STANLEY
Last Name:BURCH
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 E 105TH ST
Mailing Address - Street 2:CANARSIE MULTI SERVICE CENTER
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-2213
Mailing Address - Country:US
Mailing Address - Phone:718-307-3018
Mailing Address - Fax:
Practice Address - Street 1:567 E 105TH ST
Practice Address - Street 2:CANARSIE MULTI SERVICE CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-2213
Practice Address - Country:US
Practice Address - Phone:718-307-3018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6603101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)