Healthcare Provider Details
I. General information
NPI: 1144351586
Provider Name (Legal Business Name): ROBERT S. CHANG PH.D., A.B.M.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 03/08/2007
Last Update Date: 04/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
801 VASSAR DR NE
ALBUQUERQUE NM
87106-2725
US
IV. Provider business mailing address
801 VASSAR DR NE
ALBUQUERQUE NM
87106-2725
US
V. Phone/Fax
- Phone: 505-248-4046
- Fax:
- Phone: 505-248-4046
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103T00000X |
| Taxonomy | Psychologist |
| License Number | 1248 |
| License Number State | NM |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Psychologist |
| License Number | 1248 |
| License Number State | NM |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TA0700X |
| Taxonomy | Adult Development & Aging Psychologist |
| License Number | 1248 |
| License Number State | NM |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TB0200X |
| Taxonomy | Cognitive & Behavioral Psychologist |
| License Number | 1248 |
| License Number State | NM |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TC0700X |
| Taxonomy | Clinical Psychologist |
| License Number | 1248 |
| License Number State | NM |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TC1900X |
| Taxonomy | Counseling Psychologist |
| License Number | 1248 |
| License Number State | NM |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TE1100X |
| Taxonomy | Exercise & Sports Psychologist |
| License Number | 1248 |
| License Number State | NM |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TF0000X |
| Taxonomy | Family Psychologist |
| License Number | 1248 |
| License Number State | NM |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TF0200X |
| Taxonomy | Forensic Psychologist |
| License Number | 1248 |
| License Number State | NM |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TH0004X |
| Taxonomy | Health Psychologist |
| License Number | 1248 |
| License Number State | NM |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TH0100X |
| Taxonomy | Health Service Psychologist |
| License Number | 1248 |
| License Number State | NM |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TM1800X |
| Taxonomy | Intellectual & Developmental Disabilities Psychologist |
| License Number | 1248 |
| License Number State | NM |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TP2701X |
| Taxonomy | Group Psychotherapy Psychologist |
| License Number | 1248 |
| License Number State | NM |
| # 14 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103TP0016X |
| Taxonomy | Prescribing (Medical) Psychologist |
| License Number | 0037 |
| License Number State | NM |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
