MEDICARE: ROBERT D. ASSAEL, 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	PY0004585	FL

General Provider Information

NPI Number	:	1477965077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT D. ASSAEL, PH.D.

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

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

Authorized Official
Title or Position	:	SOLE PROPRIATOR
Name	:	DR. ROBERT D. ASSAEL
Credential	:	PH.D.
Telephone Number	:	954-979-8501

Provider Enumeration Date	:	05/30/2014
Last Update Date	:	05/30/2014

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