Provider Demographics
NPI:1083865687
Name:MATTHEWS, ROBERT DONNELL (LCPC, NCC, BCC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DONNELL
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:LCPC, NCC, BCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5907 PLAINFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-2722
Mailing Address - Country:US
Mailing Address - Phone:443-794-6926
Mailing Address - Fax:
Practice Address - Street 1:6115 FALLS RD
Practice Address - Street 2:SUITE LL-B
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-2219
Practice Address - Country:US
Practice Address - Phone:410-635-4252
Practice Address - Fax:410-377-5530
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3617101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD038738000Medicaid