Healthcare Provider Details

I. General information

NPI: 1427176023
Provider Name (Legal Business Name): ROBERT JOSEPH KOHLBRENNER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6838 E GENESEE ST
FAYETTEVILLE NY
13066-1029
US

IV. Provider business mailing address

103 THORNDIKE LN
MINOA NY
13116-1127
US

V. Phone/Fax

Practice location:
  • Phone: 315-727-0476
  • Fax: 315-656-3079
Mailing address:
  • Phone: 315-656-3079
  • Fax: 315-656-3079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number10758-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: