Provider Demographics
NPI:1518946193
Name:BURI, ROBERT J (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:BURI
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 1:5350 E DEER VALLEY DR UNIT 1411
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-4153
Mailing Address - Country:US
Mailing Address - Phone:605-868-3229
Mailing Address - Fax:
Practice Address - Street 1:7373 N SCOTTSDALE RD STE C190
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-3754
Practice Address - Country:US
Practice Address - Phone:480-442-9599
Practice Address - Fax:480-771-5858
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD375103T00000X
AZPSY-005206103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6551302Medicaid
SD6551304Medicaid
SD620005703Medicare PIN
SD6551304Medicaid
SDS103612Medicare UPIN
SDS5975Medicare PIN