Healthcare Provider Details

I. General information

NPI: 1083731186
Provider Name (Legal Business Name): ROBERT J SLICLEN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 WASHINGTON AVE
TOWNSHIP OF WASHINGTON NJ
07676-4031
US

IV. Provider business mailing address

450 WASHINGTON AVE
TOWNSHIP OF WASHINGTON NJ
07676-4031
US

V. Phone/Fax

Practice location:
  • Phone: 201-664-2566
  • Fax:
Mailing address:
  • Phone: 201-664-2566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberSI02012
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: