Provider Demographics
NPI:1902891567
Name:ROBERT L WING PSYD PC
Entity type:Organization
Organization Name:ROBERT L WING PSYD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:WING
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:413-568-0850
Mailing Address - Street 1:94 N ELM ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-1647
Mailing Address - Country:US
Mailing Address - Phone:413-568-0850
Mailing Address - Fax:413-562-1476
Practice Address - Street 1:94 N ELM ST
Practice Address - Street 2:SUITE 205
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-1647
Practice Address - Country:US
Practice Address - Phone:413-568-0850
Practice Address - Fax:413-562-1476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3254103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0513954Medicaid
17783OtherHEALTH NEW ENGLAND
W03345OtherBLUE CROSS BLUE SHIELD
17783OtherHEALTH NEW ENGLAND
W0334568Medicare ID - Type Unspecified