Provider Demographics
NPI:1366523714
Name:CHWAST, ROBERT (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:CHWAST
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17100 VAN AKEN BLVD APT 105
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-3637
Mailing Address - Country:US
Mailing Address - Phone:216-751-5629
Mailing Address - Fax:
Practice Address - Street 1:30400 DETROIT ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1855
Practice Address - Country:US
Practice Address - Phone:440-899-7708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2803103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical