Provider Demographics
NPI:1497846216
Name:MCCUE, ROBERT B II (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:MCCUE
Suffix:II
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 1:100 DEERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-4252
Mailing Address - Country:US
Mailing Address - Phone:860-552-2002
Mailing Address - Fax:
Practice Address - Street 1:100 DEERFIELD RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-4252
Practice Address - Country:US
Practice Address - Phone:860-552-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5358103G00000X
CT003233103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59819YOtherINDIVIDUAL
CT003233OtherCONNECTICUT PSYCHOLOGIST LICENSE
FLS16149Medicare UPIN
FL99446Medicare PIN