Provider Demographics
NPI:1336149541
Name:SPRAFKIN, ROBERT P (PHD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:SPRAFKIN
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 1:23 SUNSET TER.
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-1111
Mailing Address - Country:US
Mailing Address - Phone:315-625-8321
Mailing Address - Fax:315-472-2513
Practice Address - Street 1:600 SOUTH WILBUR AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-2730
Practice Address - Country:US
Practice Address - Phone:315-476-7441
Practice Address - Fax:315-476-1582
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004308103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R55847Medicare UPIN
RB4628Medicare UPIN