Provider Demographics
NPI:1790724425
Name:FEFERMAN, ROBERT M
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:FEFERMAN
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 1:170 W END AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5401
Mailing Address - Country:US
Mailing Address - Phone:212-595-1861
Mailing Address - Fax:
Practice Address - Street 1:6209 16TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-2702
Practice Address - Country:US
Practice Address - Phone:718-234-0073
Practice Address - Fax:718-236-8456
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY720649671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical