Provider Demographics
NPI:1427364512
Name:CARTWRIGHT, ROBERT EDWARD (MALLP)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:EDWARD
Last Name:CARTWRIGHT
Suffix:
Gender:M
Credentials:MALLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 WATERFORD PKWY
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-9630
Mailing Address - Country:US
Mailing Address - Phone:989-668-0701
Mailing Address - Fax:989-224-1424
Practice Address - Street 1:1505 WATERFORD PKWY
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-9630
Practice Address - Country:US
Practice Address - Phone:989-668-0701
Practice Address - Fax:989-224-1424
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007080103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical