Provider Demographics
NPI:1083942841
Name:WORSHAM, ROBERT WAYMAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WAYMAN
Last Name:WORSHAM
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 1:34 APPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:CT
Mailing Address - Zip Code:06281-2304
Mailing Address - Country:US
Mailing Address - Phone:860-928-3287
Mailing Address - Fax:
Practice Address - Street 1:34 APPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:CT
Practice Address - Zip Code:06281-2304
Practice Address - Country:US
Practice Address - Phone:860-928-3287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-05
Last Update Date:2009-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CT902103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst