Provider Demographics
NPI:1053469148
Name:CUTROW, ROBERT JAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAY
Last Name:CUTROW
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 S PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3700
Mailing Address - Country:US
Mailing Address - Phone:310-792-1823
Mailing Address - Fax:310-540-8904
Practice Address - Street 1:423 S PACIFIC COAST HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3700
Practice Address - Country:US
Practice Address - Phone:310-792-1823
Practice Address - Fax:310-540-8904
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 5343103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical