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General NPI Number Information
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NPI Number | 1023338365
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Entity Type | Organization
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Legal Business Name | ROBERT S. MARIS PH.D., P.A.
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Dates
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Enumeration Date | 06/09/2010
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Last Update Date | 06/09/2010
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Provider Practice Location Address
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Address Line | 7 OFFICE PARK DR SUITE 120
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City | LITTLE ROCK
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State | AR
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Zip | 72211-3843
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Country | US
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Telephone | 501-219-2419
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Fax | 501-219-2429
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Provider Business Mailing Address
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Address Line | 7 OFFICE PARK DR SUITE 120
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City | LITTLE ROCK
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State | AR
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Zip | 72211-3843
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Country | US
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Telephone | 501-219-2419
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Fax | 501-219-2429
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | ROBERT S MARIS
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Credential | PH.D.
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Telephone | 501-219-2419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 79-22P
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License Number State | AR
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