Provider Demographics
NPI:1376586677
Name:MCCAFFREY, ROBERT JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:MCCAFFREY
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:PO BOX 1522
Mailing Address - Street 2:1740 WESTERN AVENUE
Mailing Address - City:GUILDERLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12084-1522
Mailing Address - Country:US
Mailing Address - Phone:518-464-5060
Mailing Address - Fax:518-464-5023
Practice Address - Street 1:1740 WESTERN AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-4414
Practice Address - Country:US
Practice Address - Phone:518-464-5060
Practice Address - Fax:518-464-5023
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00843L1103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
50498CMedicare ID - Type Unspecified