Provider Demographics
NPI:1023338365
Name:ROBERT S. MARIS PH.D., P.A.
Entity type:Organization
Organization Name:ROBERT S. MARIS PH.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:501-219-2419
Mailing Address - Street 1:7 OFFICE PARK DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3843
Mailing Address - Country:US
Mailing Address - Phone:501-219-2419
Mailing Address - Fax:501-219-2429
Practice Address - Street 1:7 OFFICE PARK DR
Practice Address - Street 2:SUITE 120
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3843
Practice Address - Country:US
Practice Address - Phone:501-219-2419
Practice Address - Fax:501-219-2429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR79-22P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty