Provider Demographics
NPI:1275664724
Name:MCBRIDE, ROBERT JOHN (PCC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JOHN
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:PCC
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 5118
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-0118
Mailing Address - Country:US
Mailing Address - Phone:330-547-2733
Mailing Address - Fax:
Practice Address - Street 1:15970 ELLSWORTH RD
Practice Address - Street 2:
Practice Address - City:BERLIN CENTER
Practice Address - State:OH
Practice Address - Zip Code:44401-8754
Practice Address - Country:US
Practice Address - Phone:330-559-6409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0002010101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional