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NPI Code Detail

MEDICARE: DR. ROBERT MICHAEL SERINO PH. D.

MEDICARE: DR. ROBERT MICHAEL SERINO 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
1103T00000XPsychologist78-24PAR
2103TC0700XClinical PsychologistP551TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1104142OTHERTNVALUE OPTIONS
20013747OTHERTNBLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number : 1598784027
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT MICHAEL SERINO PH. D.
Provider Business Mailing Address
First Line : 4900 FAIRFIELD CIR
Second Line :
City : MEMPHIS
State : TN
Zip : 38117-4210
Country : US
Telephone Number : 901-761-0452
Fax Number : 800-572-6370
Provider Business Practice Location Address
First Line : 5170 SANDERLIN AVE
Second Line : SUITE 204
City : MEMPHIS
State : TN
Zip : 38117-4360
Country : US
Telephone Number : 901-761-2622
Fax Number : 901-761-2355
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2006
Last Update Date : 11/22/2011

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