Healthcare Provider Details

I. General information

NPI: 1669414835
Provider Name (Legal Business Name): ROBERT EDWARD HOOBERMAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1327 JONES DR SUITE 203
ANN ARBOR MI
48105-1892
US

IV. Provider business mailing address

1327 JONES DR SUITE 203
ANN ARBOR MI
48105-1892
US

V. Phone/Fax

Practice location:
  • Phone: 734-663-7588
  • Fax:
Mailing address:
  • Phone: 734-663-7588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301002112
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: