Provider Demographics
NPI:1750031688
Name:SCHLOSSER, ROBERT NICHOLAS
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:NICHOLAS
Last Name:SCHLOSSER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:VERNON ROCKVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06066-3832
Mailing Address - Country:US
Mailing Address - Phone:207-242-5442
Mailing Address - Fax:
Practice Address - Street 1:29 CENTER ST
Practice Address - Street 2:
Practice Address - City:VERNON ROCKVILLE
Practice Address - State:CT
Practice Address - Zip Code:06066-3832
Practice Address - Country:US
Practice Address - Phone:207-242-5442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0785335106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician