Provider Demographics
NPI:1104910371
Name:CHERNEY, ROBERT S (PHD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:CHERNEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1195 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTON
Mailing Address - State:MA
Mailing Address - Zip Code:01746-2259
Mailing Address - Country:US
Mailing Address - Phone:508-429-1834
Mailing Address - Fax:
Practice Address - Street 1:1195 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-2259
Practice Address - Country:US
Practice Address - Phone:508-429-1834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3857103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW03864OtherBC/BS
MA724191OtherTUFTS
MAW03864Medicare ID - Type Unspecified