Provider Demographics
NPI:1104991165
Name:RADOSTA, ROBERT DAVID (EDD MS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DAVID
Last Name:RADOSTA
Suffix:
Gender:M
Credentials:EDD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2716
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75168-8716
Mailing Address - Country:US
Mailing Address - Phone:972-816-8772
Mailing Address - Fax:972-617-0007
Practice Address - Street 1:206 S ROGERS ST
Practice Address - Street 2:SUITE 205
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75168-8716
Practice Address - Country:US
Practice Address - Phone:972-816-8772
Practice Address - Fax:972-617-0007
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11360800101YA0400X
TX2991101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0952665Medicaid