Provider Demographics
NPI:1386725323
Name:MAIDEN, ROBERT JOSEPH
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:MAIDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MARTIN ST, SUITE 3
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895
Mailing Address - Country:US
Mailing Address - Phone:585-593-9815
Mailing Address - Fax:585-596-4048
Practice Address - Street 1:12 MARTIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895
Practice Address - Country:US
Practice Address - Phone:585-593-1859
Practice Address - Fax:585-593-2465
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006688-2103T00000X
NY006688103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00781659Medicaid
NY000500140001OtherBLUE SHIELD WESTERN NY
NY260011314OtherRAIL ROAD MEDICARE
NY6107819OtherIHA
NYR53888Medicare UPIN