Healthcare Provider Details

I. General information

NPI: 1649382854
Provider Name (Legal Business Name): ROBERT STEVEN COLEN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 CENTRAL AVENUE ROOM 213 SOUTHWEST CT MENTAL HEALTH SYSTEM
BRIDGEPORT CT
06610
US

IV. Provider business mailing address

1635 CENTRAL AVENUE ROOM 213 SOUTHWEST CT MENTAL HEALTH SYSTEM SANDRA GRAZY
BRIDGEPORT CT
06610
US

V. Phone/Fax

Practice location:
  • Phone: 203-551-7660
  • Fax: 203-551-7481
Mailing address:
  • Phone: 203-551-7660
  • Fax: 203-551-7481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number000765
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number000765
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: