Provider Demographics
NPI:1568489532
Name:EGRI, ROBERT (MA LMSW LMFT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:EGRI
Suffix:
Gender:M
Credentials:MA LMSW LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2479 PETERS RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9499
Mailing Address - Country:US
Mailing Address - Phone:734-665-5050
Mailing Address - Fax:734-665-5050
Practice Address - Street 1:2479 PETERS RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9499
Practice Address - Country:US
Practice Address - Phone:734-665-5050
Practice Address - Fax:734-665-5050
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRE012511101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI2072Medicare PIN
MNMI2072Medicare UPIN