MEDICARE: ROBERT ALAN RUCHINSKAS PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	36074	TX
2	103T00000X	Psychologist	PA007810L	PA
3	103T00000X	Psychologist	35SI00457100	NJ
4	103T00000X	Psychologist	36074	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528056736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT ALAN RUCHINSKAS PSY.D.

Provider Business Mailing Address
First Line	:	1440 EMPIRE CENTRAL
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75247
Country	:	US
Telephone Number	:	214-648-4646
Fax Number	:	214-648-4947

Provider Business Practice Location Address
First Line	:	5323 HARRY HINNES BLVD.
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-7208
Country	:	US
Telephone Number	:	214-648-4646
Fax Number	:	214-648-4947

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	02/13/2023

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