Basic Information
| Provider Information | |||||||||
| NPI: | 1528056736 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUCHINSKAS | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 845347 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752845347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146484646 | ||||||||
| FaxNumber: | 2146484947 | ||||||||
| Practice Location | |||||||||
| Address1: | 5323 HARRY HINNES BLVD. | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753907208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146484646 | ||||||||
| FaxNumber: | 2146484947 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2005 | ||||||||
| LastUpdateDate: | 12/13/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PA007810L | PA | N | Behavioral Health & Social Service Providers | Psychologist | 103T00000X | 35SI00457100 | NJ | N | Behavioral Health & Social Service Providers | Psychologist | 103T00000X | 36074 | TX | Y | Behavioral Health & Social Service Providers | Psychologist | 103G00000X | 36074 | TX | N | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
ID Information
| ID | Type | State | Issuer | Description | 0019658220001 | 05 | PA | MEDICAID | 6943101 | 05 | NJ | MEDICAID |