Provider Demographics
NPI:1659446615
Name:REGAL, ROBERT ABRAHAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ABRAHAM
Last Name:REGAL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:503 GRASSLANDS RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1503
Mailing Address - Country:US
Mailing Address - Phone:914-347-4797
Mailing Address - Fax:913-347-4705
Practice Address - Street 1:503 GRASSLANDS RD
Practice Address - Street 2:SUITE 107
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1503
Practice Address - Country:US
Practice Address - Phone:914-347-4797
Practice Address - Fax:913-347-4705
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009578-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV95631 RRMedicare ID - Type UnspecifiedPSYCHOLOGIST