Provider Demographics
NPI:1275856510
Name:DOUGLAS, ROBERT LESLIE (LMHC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LESLIE
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FISKE PL
Mailing Address - Street 2:SUITE 228
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-3205
Mailing Address - Country:US
Mailing Address - Phone:914-960-4302
Mailing Address - Fax:
Practice Address - Street 1:10 FISKE PL
Practice Address - Street 2:SUITE 228
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-3205
Practice Address - Country:US
Practice Address - Phone:914-960-4302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005329-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health