Provider Demographics
NPI:1508082306
Name:SEMEL, ROBERT A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:SEMEL
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 1:1242 E 70TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5728
Mailing Address - Country:US
Mailing Address - Phone:718-444-7347
Mailing Address - Fax:718-444-7347
Practice Address - Street 1:2355 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3150
Practice Address - Country:US
Practice Address - Phone:718-251-3271
Practice Address - Fax:718-444-7347
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010642-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV95022Medicare ID - Type Unspecified