Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 1182 | MA |
Y | 103T00000X | Psychologist | 1182 | MA |
NPI | 1003923251 |
---|---|
Provider Name | Dr. Robert Eugene Bates |
First Address | West Springfield, MA 01089-1024 |
Second Address | West Springfield, MA 01089-1024 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1305263 | (05) | MA |