Provider Demographics
NPI:1952683500
Name:FAY, ROBERT ABRAHAM (BA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ABRAHAM
Last Name:FAY
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2904 PARKLAND DR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-6649
Mailing Address - Country:US
Mailing Address - Phone:407-484-8399
Mailing Address - Fax:
Practice Address - Street 1:1350 N ORANGE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4945
Practice Address - Country:US
Practice Address - Phone:407-644-4367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional