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General NPI Number Information
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NPI Number | 1063634939
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Entity Type | Individual
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Provider Name | ROBERT ALLAN BUTZ JR. PH.D.
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Gender | Male
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 05/21/2018
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Provider Practice Location Address
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Address Line | 20 LONGWOOD DR
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City | CLIFTON PARK
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State | NY
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Zip | 12065
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Country | US
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Telephone | 518-371-7540
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 618
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City | CLIFTON PARK
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State | NY
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Zip | 12065
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Country | US
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Telephone | 518-371-7540
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 62251
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License Number State | NY
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