Robert Laurentz, PSY.D.
Individual provider Active NPI Clinical Psychologist · Ithaca, NY
NPI 1497843437 · NPPES record last updated Jun 19, 2008
Key facts
- NPI
- 1497843437
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 011909 (NY)
- Practice address
- 207 E Court St
Ithaca, NY 14850-4203 - Phone
- (607) 339-1757
- NPI assigned
- Oct 11, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5008 | FL | MD | Clinical Psychologist |
| 71004446 | IL | MD | Clinical Psychologist |
| 011909 | NY | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lisa C. McElroy, PHD, Psychology, PC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 011909 | NY | Yes |
| Clinical Psychologist | 103TC0700X | 5008 | FL | |
| Clinical Psychologist | 103TC0700X | 1835 | AZ | |
| Clinical Psychologist | 103TC0700X | 71004446 | IL |
Addresses
Primary practice location
207 E Court St
Ithaca, NY 14850-4203
Mailing address
9 Yardley GRN
Ithaca, NY 14850-1260
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01650279 | Medicaid | NY |
Other providers in Ithaca, NY
- Susan Laratta
- William Larsen
- Lance E Lauchle
- Mary Lauppe
- Laura a. Staubes BSN-RN, PLLC
- Debra Lavigne
- Edward James Lavigne
- Adam Law
- Erica Lawlor
- Elizabeth Mary Lawrence
All providers in Ithaca, NY · Clinical Psychologist in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 19, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.