Healthcare Provider Details

I. General information

NPI: 1386775617
Provider Name (Legal Business Name): ROBERT J. CIPRIANO JR. PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10031 PINES BOULEVARD (SUITE 240)
PEMBROKE PINES FL
33024-6180
US

IV. Provider business mailing address

10031 PINES BLVD STE 240
PEMBROKE PINES FL
33024-6180
US

V. Phone/Fax

Practice location:
  • Phone: 305-528-7309
  • Fax:
Mailing address:
  • Phone: 305-528-7309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY6632
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY6632
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: