Provider Demographics
NPI:1235200874
Name:SHER, ROBERT SCOTT (PSY D)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SCOTT
Last Name:SHER
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:PO BOX 25904
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-0904
Mailing Address - Country:US
Mailing Address - Phone:505-440-0456
Mailing Address - Fax:
Practice Address - Street 1:2403 SAN MATEO BLVD NE
Practice Address - Street 2:SUITE W-4
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4058
Practice Address - Country:US
Practice Address - Phone:505-440-0456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0084711106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM14884577Medicaid