Provider Demographics
NPI:1992801880
Name:DE CARLI, ROBERT PAUL (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PAUL
Last Name:DE CARLI
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 1:11 SOUTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3656
Mailing Address - Country:US
Mailing Address - Phone:860-346-1266
Mailing Address - Fax:
Practice Address - Street 1:11 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3656
Practice Address - Country:US
Practice Address - Phone:860-346-1266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCTLIC1570103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0004257507OtherAETNA
060001570CT02OtherANTHEM BCBS
IP294886OtherMAGELLAN
134524OtherVALUE OPTIONS
153151OtherMANAGED HEALTH NETWORK
73825OtherCIGNA BH
OV2128OtherHEALTH NET
P568966OtherOXFORD HEALTH
015700OtherCTCARE
279844OtherPRIVATE HEALTH CARE SYSTE
OV2128OtherHEALTH NET