Provider Demographics
NPI:1366526923
Name:DELL, ROBERT (PSYD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:DELL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-3581
Mailing Address - Country:US
Mailing Address - Phone:860-646-9664
Mailing Address - Fax:860-643-4074
Practice Address - Street 1:200 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-3581
Practice Address - Country:US
Practice Address - Phone:860-646-9664
Practice Address - Fax:860-643-4074
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002315103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT61-89608OtherUNITED HEALTH CARE
CT234043OtherMHN
CT2036639OtherCIGNA
CT060002315CT07OtherANTHEM