Provider Demographics
NPI:1528056736
Name:RUCHINSKAS, ROBERT ALAN (PSYD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALAN
Last Name:RUCHINSKAS
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 1:1440 EMPIRE CENTRAL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247
Mailing Address - Country:US
Mailing Address - Phone:214-648-4646
Mailing Address - Fax:214-648-4947
Practice Address - Street 1:5323 HARRY HINNES BLVD.
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7208
Practice Address - Country:US
Practice Address - Phone:214-648-4646
Practice Address - Fax:214-648-4947
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36074103G00000X, 103T00000X
PAPA007810L103T00000X
NJ35SI00457100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019658220001Medicaid
NJ6943101Medicaid
S21965Medicare UPIN
PA0019658220001Medicaid