MEDICARE: DR. ROBERT D ASSAEL PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY0004585	FL

General Provider Information

NPI Number	:	1215042502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT D ASSAEL PHD

Provider Business Mailing Address
First Line	:	1132 W CYPRESS DR
Second Line	:	V-17
City	:	POMPANO BEACH
State	:	FL
Zip	:	33069-4107
Country	:	US
Telephone Number	:	954-979-8501
Fax Number	:	954-979-8502

Provider Business Practice Location Address
First Line	:	6750 N ANDREWS AVE
Second Line	:	SUITE 200 - CYPRESS PARK WEST
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-2173
Country	:	US
Telephone Number	:	954-979-8501
Fax Number	:	954-979-8502

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	10/20/2012

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