Provider Demographics
NPI:1669578126
Name:ANDERSON, ROBERT W (PH D)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895-0062
Mailing Address - Country:US
Mailing Address - Phone:585-593-1991
Mailing Address - Fax:585-593-7104
Practice Address - Street 1:45 N BROAD ST
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-1224
Practice Address - Country:US
Practice Address - Phone:585-593-3991
Practice Address - Fax:585-593-7104
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007903-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist