Provider Demographics
NPI:1801885595
Name:DEMERATH, ROBERT RICHARD (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RICHARD
Last Name:DEMERATH
Suffix:
Gender:M
Credentials:PHD
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Other - Credentials:
Mailing Address - Street 1:388 EVANS ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5626
Mailing Address - Country:US
Mailing Address - Phone:716-632-7066
Mailing Address - Fax:716-632-7066
Practice Address - Street 1:388 EVANS ST
Practice Address - Street 2:SUITE 303
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5626
Practice Address - Country:US
Practice Address - Phone:716-632-7066
Practice Address - Fax:716-632-7066
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2007-09-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY010385103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000511044003OtherBLUECROSS BLUESHIELD
NY01276273Medicaid
NY01276273Medicaid
NY54580Medicare UPIN