Basic Information
| Provider Information | |||||||||
| NPI: | 1366462038 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DWORKIN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 ELMWOOD AVE | ||||||||
| Address2: | BOX 604 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146420001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852755982 | ||||||||
| FaxNumber: | 5857560169 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 ELMWOOD AVE | ||||||||
| Address2: | BOX 604 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146420001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852755982 | ||||||||
| FaxNumber: | 5857560169 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 006933 | NY | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 361562 | 01 | NY | MVP PROVIDER ID | OTHER | G0180921590 | 01 | NY | BLUE CHOICE GROUP | OTHER | S06933-6W | 01 | NY | WORKER'S COMP | OTHER | 000912159001 | 01 | NY | BS WNY/HEALTHNOW | OTHER | 5399016 | 01 | NY | GHI | OTHER | 7843175 | 01 | NY | AETNA | OTHER | 2222 | 01 | NY | BLUE SHIELD GROUP | OTHER | 00040345901 | 01 | NY | UNIVERA | OTHER | 01719768 | 05 | NY | MEDICAID | MDG077 | 01 | NY | PREFERRED CARE | OTHER |