Healthcare Provider Details

I. General information

NPI: 1083676092
Provider Name (Legal Business Name): ROBERT STEPHEN MARIS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 OFFICE PARK DR STE 120
LITTLE ROCK AR
72211-3862
US

IV. Provider business mailing address

7 OFFICE PARK DR STE 120
LITTLE ROCK AR
72211-3862
US

V. Phone/Fax

Practice location:
  • Phone: 501-219-2419
  • Fax: 501-228-7347
Mailing address:
  • Phone: 501-219-2419
  • Fax: 501-228-7347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number7922P
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: