Provider Demographics
NPI:1417918731
Name:SIDELL, ROBERT BRIAN (PYSD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRIAN
Last Name:SIDELL
Suffix:
Gender:M
Credentials:PYSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 BROOKGREEN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-6003
Mailing Address - Country:US
Mailing Address - Phone:706-787-3780
Mailing Address - Fax:
Practice Address - Street 1:1414 BROOKGREEN DR
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-6003
Practice Address - Country:US
Practice Address - Phone:706-787-3780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical