Provider Demographics
NPI:1477965077
Name:ROBERT D. ASSAEL, PH.D.
Entity Type:Organization
Organization Name:ROBERT D. ASSAEL, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:ASSAEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-979-8501
Mailing Address - Street 1:1132 W CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-4107
Mailing Address - Country:US
Mailing Address - Phone:954-979-8501
Mailing Address - Fax:
Practice Address - Street 1:6750 N ANDREWS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-2173
Practice Address - Country:US
Practice Address - Phone:954-979-8501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-30
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004585103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59506Medicare PIN