Provider Demographics
NPI:1720132848
Name:ROBERT B CLIFT PH D PA
Entity Type:Organization
Organization Name:ROBERT B CLIFT PH D PA
Other - Org Name:PSYCHOMETRIC LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:CLIFT
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:612-250-4113
Mailing Address - Street 1:PO BOX 227
Mailing Address - Street 2:
Mailing Address - City:MARINE
Mailing Address - State:MN
Mailing Address - Zip Code:55047-0227
Mailing Address - Country:US
Mailing Address - Phone:612-250-4113
Mailing Address - Fax:651-351-0490
Practice Address - Street 1:6950 FRANCE AVE SOUTH
Practice Address - Street 2:SUITE 103
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55035
Practice Address - Country:US
Practice Address - Phone:612-250-4113
Practice Address - Fax:651-351-0490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1748103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty