Provider Demographics
NPI:1225377955
Name:DUGAN, ROBERT EDMUND JR (CASAC T 28543)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:EDMUND
Last Name:DUGAN
Suffix:JR
Gender:M
Credentials:CASAC T 28543
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 FLATBUSH AVE
Mailing Address - Street 2:APT 6P
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-4966
Mailing Address - Country:US
Mailing Address - Phone:718-522-0371
Mailing Address - Fax:
Practice Address - Street 1:590 FLATBUSH AVE
Practice Address - Street 2:APT 6P
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-4966
Practice Address - Country:US
Practice Address - Phone:718-522-0371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28543101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBROOKLYNROBMedicaid