Provider Demographics
NPI:1407956147
Name:SLABSKY, ROMAN (PSYD)
Entity Type:Individual
Prefix:
First Name:ROMAN
Middle Name:
Last Name:SLABSKY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 BEALS ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-6011
Mailing Address - Country:US
Mailing Address - Phone:617-697-9252
Mailing Address - Fax:617-232-4145
Practice Address - Street 1:233 HARVARD ST
Practice Address - Street 2:SUITE 36
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5069
Practice Address - Country:US
Practice Address - Phone:617-697-9252
Practice Address - Fax:617-232-4145
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8407103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
U49395OtherAMERIHEALTH
MA1854534Medicaid
MAW06456OtherBLUECROSS BLUESHIELD
MA1854534Medicaid