Robert Boback, LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

44.001421 Issued in CT

Practice address

76 Lewis Dr
Fairfield, CT 06825-1920

Phone

(203) 694-9895

NPI assigned

Sep 1, 2021

Last updated

Sep 1, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1630454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630454400000",
    "number": "1326716689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "76 LEWIS DR",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068251920",
            "telephone_number": "203-694-9895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "76 LEWIS DR",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068251920",
            "telephone_number": "203-694-9895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOBACK",
        "first_name": "ROBERT",
        "name_prefix": "Mr.",
        "credential": "LADC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-09-01",
        "last_updated": "2021-09-01",
        "certification_date": "2021-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CT",
            "license": "44.001421",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Todd Evan Bloom, M.S., D.D.S.
• Blooming Bonds Therapy LLC
• Elaine Bluestein, LCSW
• Harvey Jay Bluestein, M.D.
• John Boamah Jr., DC
• Ingri Boe-Wiegaard, L. AC.
• Nicholas S Bogannam, D.C.
• Bojana Jankovic Weatherly MD of New Jersey PC
• John Scott Bomann, D.O.
• Judy Mary Bonadio, LCSW

• Addiction (Substance Use Disorder) Counselor in Fairfield, CT
• Providers in Fairfield, CT by specialty
• Addiction (Substance Use Disorder) Counselor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.