Provider Demographics
NPI:1811023450
Name:BURCHETT, ROBERT WILLIAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:BURCHETT
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 1:1030 FRANKLIN AVE
Mailing Address - Street 2:#22
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2102
Mailing Address - Country:US
Mailing Address - Phone:516-825-1038
Mailing Address - Fax:516-825-1038
Practice Address - Street 1:1030 FRANKLIN AVE
Practice Address - Street 2:#22
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-2102
Practice Address - Country:US
Practice Address - Phone:516-825-1038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6901103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV25871Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST