Provider Demographics
NPI:1952455008
Name:TEITELBAUM, ROBERT (LMFT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:TEITELBAUM
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-3444
Mailing Address - Country:US
Mailing Address - Phone:607-272-9454
Mailing Address - Fax:
Practice Address - Street 1:103 W SENECA ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4157
Practice Address - Country:US
Practice Address - Phone:607-379-4191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2012-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000628106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist