Healthcare Provider Details

I. General information

NPI: 1912119579
Provider Name (Legal Business Name): ROBERT R ABEL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ROBIN R ABEL PH.D.

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 12/20/2019
Certification Date: 12/20/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 N COUNTRY CLUB DR
MESA AZ
85201-3307
US

IV. Provider business mailing address

1025 N COUNTRY CLUB DR
MESA AZ
85201-3307
US

V. Phone/Fax

Practice location:
  • Phone: 480-472-0502
  • Fax: 480-472-0705
Mailing address:
  • Phone: 480-472-0502
  • Fax: 480-472-0705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1539
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: