Healthcare Provider Details

I. General information

NPI: 1396953071
Provider Name (Legal Business Name): ROBERT JOSEPH MAICHROWICZ PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 WILDER TOWER UNIVERSITY OF MEMPHIS
MEMPHIS TN
38152-0001
US

IV. Provider business mailing address

214 WILDER TOWER UNIVERSITY OF MEMPHIS
MEMPHIS TN
38152-0001
US

V. Phone/Fax

Practice location:
  • Phone: 901-678-3549
  • Fax: 901-678-4895
Mailing address:
  • Phone: 901-678-3549
  • Fax: 901-678-4895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberP0000002112
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: