Provider Demographics
NPI:1134148844
Name:BREWSTER, ROBERT M (PHD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:BREWSTER
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 1:810 SUNRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3280
Mailing Address - Country:US
Mailing Address - Phone:330-666-3570
Mailing Address - Fax:
Practice Address - Street 1:822 PORTAGE TRL
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-3053
Practice Address - Country:US
Practice Address - Phone:330-665-9344
Practice Address - Fax:330-665-4572
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4068103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBRCP31601Medicare ID - Type Unspecified