Provider Demographics
NPI:1235395419
Name:BIVENS, ROBERT KYLE (LCSW-C , LICSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:KYLE
Last Name:BIVENS
Suffix:
Gender:M
Credentials:LCSW-C , LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 MADISON ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-2311
Mailing Address - Country:US
Mailing Address - Phone:202-750-1246
Mailing Address - Fax:
Practice Address - Street 1:604 SOLAREX CT
Practice Address - Street 2:SUITE 201
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-7005
Practice Address - Country:US
Practice Address - Phone:301-663-8263
Practice Address - Fax:301-682-5326
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD134621041C0700X
DCLC500797371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC047788688Medicaid