Provider Demographics
NPI:1922180736
Name:LEVIN, ROBERT BRONSON (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRONSON
Last Name:LEVIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:BRONSON
Other - Middle Name:
Other - Last Name:LEVIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1150 S BOBOLINK DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-7205
Mailing Address - Country:US
Mailing Address - Phone:262-786-1139
Mailing Address - Fax:262-785-1139
Practice Address - Street 1:16535 W BLUEMOUND RD
Practice Address - Street 2:# 200
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-5936
Practice Address - Country:US
Practice Address - Phone:262-542-3255
Practice Address - Fax:262-821-6180
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2205-057103G00000X, 103TF0200X
WI2205103TC0700X
DC1188103TC0700X, 103TF0200X
VA0810000987103TC0700X
MD1695103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0810000987OtherLICENSE
MD1695OtherLICENSE
WI2205-057OtherLICENSE
DC1188OtherLICENSE