MEDICARE: DR. ROBERT CHWAST PH.D

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	2803	OH

General Provider Information

NPI Number	:	1366523714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT CHWAST PH.D

Provider Business Mailing Address
First Line	:	17100 VAN AKEN BLVD APT 105
Second Line	:	SUITE 105
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-3637
Country	:	US
Telephone Number	:	216-751-5629
Fax Number	:

Provider Business Practice Location Address
First Line	:	30400 DETROIT ROAD
Second Line	:	SUITE 210
City	:	WESTLAKE
State	:	OH
Zip	:	44145-1855
Country	:	US
Telephone Number	:	440-899-7708
Fax Number	:

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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