Provider Demographics
NPI:1083630867
Name:PEZZOTE, ROBERT ANGELO (PHARMD,RPH,NCC,CCMHC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ANGELO
Last Name:PEZZOTE
Suffix:
Gender:M
Credentials:PHARMD,RPH,NCC,CCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 ALTON RD # 10
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-2421
Mailing Address - Country:US
Mailing Address - Phone:917-673-5003
Mailing Address - Fax:
Practice Address - Street 1:328 W 19TH ST
Practice Address - Street 2:3A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-3951
Practice Address - Country:US
Practice Address - Phone:917-673-5003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000080101YM0800X
NY0495171835P1300X
CA534701835P1300X
FLPS451361835P1300X
CA41291106H00000X
NV162901835P1300X
NC207801835P1300X
MA218311835P1300X
CTPCT00100371835P1300X
CALPC118101YP2500X
FLMH11320101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1835P1300XPharmacy Service ProvidersPharmacistPsychiatric
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional