Healthcare Provider Details

I. General information

NPI: 1487728796
Provider Name (Legal Business Name): ROBERT JOEL LANDY PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 GOODLETTE RD N STE 203
NAPLES FL
34102-5499
US

IV. Provider business mailing address

1112 GOODLETTE RD N STE 203
NAPLES FL
34102-5499
US

V. Phone/Fax

Practice location:
  • Phone: 239-263-3312
  • Fax: 239-261-0080
Mailing address:
  • Phone: 239-263-3312
  • Fax: 239-261-0080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH0001430
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: