Provider Demographics
NPI:1215042502
Name:ASSAEL, ROBERT D (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:ASSAEL
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 1:1132 W CYPRESS DR
Mailing Address - Street 2:V-17
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-4107
Mailing Address - Country:US
Mailing Address - Phone:954-979-8501
Mailing Address - Fax:954-979-8502
Practice Address - Street 1:6750 N ANDREWS AVE
Practice Address - Street 2:SUITE 200 - CYPRESS PARK WEST
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-2173
Practice Address - Country:US
Practice Address - Phone:954-979-8501
Practice Address - Fax:954-979-8502
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2012-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004585103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59506Medicare ID - Type UnspecifiedBLUE CROSS BLUE SHIELD