Provider Demographics
NPI:1407068257
Name:KITTLE, ROBERT NEIL SR (MA,MDIV,LCPC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:NEIL
Last Name:KITTLE
Suffix:SR
Gender:M
Credentials:MA,MDIV,LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 KLAUSMIER RD
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-1418
Mailing Address - Country:US
Mailing Address - Phone:410-529-9335
Mailing Address - Fax:
Practice Address - Street 1:16 GREENMEADOW DR
Practice Address - Street 2:SUITE 106
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-3200
Practice Address - Country:US
Practice Address - Phone:410-561-9584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0534101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional