Provider Demographics
NPI:1770046658
Name:POWER, ROBERT ELLIS JR (PH D)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ELLIS
Last Name:POWER
Suffix:JR
Gender:M
Credentials:PH D
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Mailing Address - Street 1:77 SANDS ST FL 6
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1431
Mailing Address - Country:US
Mailing Address - Phone:516-586-0001
Mailing Address - Fax:516-530-1838
Practice Address - Street 1:1007 ATLANTIC AVE APT 4D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-3469
Practice Address - Country:US
Practice Address - Phone:516-586-0001
Practice Address - Fax:516-530-1838
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYEXEMPT101YP1600X
171M00000X
NY3476172V00000X, 175T00000X
NY35587101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARP-3476OtherNY CERTIFICATION BOARD - ASAP OF NEW YORK
GA01799OtherALCOHOL AND DRUG ABUSE CERTIFICATION BOARD OF GEORGIA (ADACBGA)
NY35587OtherOFFICE OF ADDICTION SERVICES AND SUPPORTS