Provider Demographics
NPI:1801174511
Name:SVENSON, ROBERT ERIC
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ERIC
Last Name:SVENSON
Suffix:
Gender:M
Credentials:
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 38
Mailing Address - Street 2:13 ELM STREET
Mailing Address - City:PERU
Mailing Address - State:NY
Mailing Address - Zip Code:12972-0038
Mailing Address - Country:US
Mailing Address - Phone:518-643-8641
Mailing Address - Fax:
Practice Address - Street 1:13 ELM STREET
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:NY
Practice Address - Zip Code:12972-0038
Practice Address - Country:US
Practice Address - Phone:518-643-8641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003360-1101YM0800X
NY000565-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health