MEDICARE: DR. ADRIENNE ROBEK PHD, BCBA-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	103K00000X	Behavior Analyst	1052417	NY
2	103T00000X	Psychologist	018076	NY

General Provider Information

NPI Number	:	1487989794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADRIENNE ROBEK PHD, BCBA-D

Provider Business Mailing Address
First Line	:	4004 36TH AVE APT 1C
Second Line	:	#1C
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-1543
Country	:	US
Telephone Number	:	917-577-4909
Fax Number	:

Provider Business Practice Location Address
First Line	:	4004 36TH AVE APT 1C
Second Line	:	#1C
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-1543
Country	:	US
Telephone Number	:	917-577-4909
Fax Number	:

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

Provider Enumeration Date	:	10/05/2009
Last Update Date	:	07/25/2013

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