Provider Demographics
NPI:1871952051
Name:DENTON, ROBERT (PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:DENTON
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14100 CEDAR RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3234
Mailing Address - Country:US
Mailing Address - Phone:216-307-4454
Mailing Address - Fax:
Practice Address - Street 1:14100 CEDAR RD STE 100
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44121-3234
Practice Address - Country:US
Practice Address - Phone:216-307-4454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-17
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6540103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0221011Medicaid