Provider Demographics
NPI:1831125673
Name:FELS, ROBERT ALAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALAN
Last Name:FELS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9971 BAYWATER DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-2142
Mailing Address - Country:US
Mailing Address - Phone:561-929-4103
Mailing Address - Fax:561-477-6612
Practice Address - Street 1:9971 BAYWATER DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-2142
Practice Address - Country:US
Practice Address - Phone:561-929-4103
Practice Address - Fax:561-477-6612
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002882101YM0800X
FLMT000597101YM0800X
FLPY 7932103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ1234OtherBLUECROSS/BLUESHIELD