Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 2699 | MA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 2699 | MA |
N | 103G00000X | Clinical Psychologist | 2699 | MA |
N | 103TC0700X | Clinical Psychologist | 2699 | MA |
N | 103TF0200X | Forensic Psychologist | 2699 | MA |
N | 103TP2701X | Group Psychotherapist | 2699 | MA |
NPI | 1194945436 |
---|---|
Provider Name | Robert Bruce Alexander |
First Address | North Eastham, MA 02651-0702 |
Second Address | North Eastham, MA 02651-0702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2007 |
Last Update Date | 08/07/2007 |