Provider Demographics
NPI:1821179870
Name:MINER, ROBERT C (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:MINER
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 1:3619 PARK EAST DR
Mailing Address - Street 2:SUITE 313
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4330
Mailing Address - Country:US
Mailing Address - Phone:216-591-0500
Mailing Address - Fax:216-591-0550
Practice Address - Street 1:3619 PARK EAST DR
Practice Address - Street 2:SUITE 313
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4330
Practice Address - Country:US
Practice Address - Phone:216-591-0500
Practice Address - Fax:216-591-0550
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4826103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00127008OtherRAILROAD MEDICARE
OH0986081Medicaid
OH000000137850OtherANTHEM
OHP00127008OtherRAILROAD MEDICARE