Provider Demographics
NPI:1285735498
Name:CHINISCI, ROBERT A (PHD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:CHINISCI
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 1:4770 E ILIFF AVE STE 234
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-6000
Mailing Address - Country:US
Mailing Address - Phone:303-757-4142
Mailing Address - Fax:
Practice Address - Street 1:4770 E ILIFF AVE STE 234
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6000
Practice Address - Country:US
Practice Address - Phone:303-757-4142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO565103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
90536Medicare ID - Type Unspecified