Provider Demographics
NPI:1346331303
Name:SMITH, ROBERT W (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 W MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-2106
Mailing Address - Country:US
Mailing Address - Phone:276-228-6900
Mailing Address - Fax:276-228-6910
Practice Address - Street 1:1035 W MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-2106
Practice Address - Country:US
Practice Address - Phone:276-228-6900
Practice Address - Fax:276-228-6910
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003284103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA179565OtherANTHEM BCBS PROVIDER #
VA179565OtherANTHEM BCBS PROVIDER #
VA00W559S01Medicare ID - Type UnspecifiedPROVIDER NUMBER