Provider Demographics
NPI:1619426806
Name:CORMIER, ROBERT (PHD, BCBA)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:CORMIER
Suffix:
Gender:M
Credentials:PHD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 FRANCIS PL
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-2462
Mailing Address - Country:US
Mailing Address - Phone:314-632-6206
Mailing Address - Fax:314-658-9374
Practice Address - Street 1:716 FRANCIS PL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-2462
Practice Address - Country:US
Practice Address - Phone:314-632-6206
Practice Address - Fax:314-658-9374
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-28
Last Update Date:2017-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016035860103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOBACB248779OtherBEHAVIOR ANALYSIS CERTIFICATION BOARD - BACB248779