Provider Demographics
NPI:1164565818
Name:BICKETT, ROBERT NEWMAN (PSY D)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:NEWMAN
Last Name:BICKETT
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MANOR DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-2298
Mailing Address - Country:US
Mailing Address - Phone:502-349-1300
Mailing Address - Fax:502-350-1177
Practice Address - Street 1:101 MANOR DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2298
Practice Address - Country:US
Practice Address - Phone:502-349-1300
Practice Address - Fax:502-350-1177
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1284103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0988101Medicare ID - Type UnspecifiedINDIVIDUAL #
KYP63925Medicare UPIN
KY9881Medicare ID - Type UnspecifiedGROUP #