Provider Demographics
NPI:1508914615
Name:HORWITZ, ROBERT ALAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALAN
Last Name:HORWITZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 BRADLEY STREET
Mailing Address - Street 2:LOWER LEVEL A
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-1182
Mailing Address - Country:US
Mailing Address - Phone:203-789-1086
Mailing Address - Fax:203-789-1086
Practice Address - Street 1:258 BRADLEY STREET
Practice Address - Street 2:LOWER LEVEL A
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-1182
Practice Address - Country:US
Practice Address - Phone:208-789-1086
Practice Address - Fax:203-789-1086
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000662103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004008561Medicaid
CT680000042Medicare ID - Type Unspecified