Provider Demographics
NPI:1649756867
Name:OGLE, ROBERT RAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RAY
Last Name:OGLE
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 1:55 OLD POST RD NO 2 # 2C
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6200
Mailing Address - Country:US
Mailing Address - Phone:475-758-0213
Mailing Address - Fax:
Practice Address - Street 1:55 OLD POST RD NO 2 # 2C
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6200
Practice Address - Country:US
Practice Address - Phone:475-758-0213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT4138103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program