Provider Demographics
NPI:1649497397
Name:KRUGER, ROBERT S (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:KRUGER
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 1:29 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-3749
Mailing Address - Country:US
Mailing Address - Phone:203-227-2161
Mailing Address - Fax:203-227-1769
Practice Address - Street 1:29 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3749
Practice Address - Country:US
Practice Address - Phone:203-227-2161
Practice Address - Fax:203-227-1769
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000681103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000681OtherLICENSE #
CT000681OtherLICENSE #