Provider Demographics
NPI:1467444125
Name:UNDERWOOD, ROBERT ALLEN (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALLEN
Last Name:UNDERWOOD
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 1:100 E LIBERTY ST STE 800
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1428
Mailing Address - Country:US
Mailing Address - Phone:502-582-7484
Mailing Address - Fax:502-582-7646
Practice Address - Street 1:220 ABRAHAM FLEXNER WAY
Practice Address - Street 2:6TH FLOOR PSYCHOLOGY DEPARTMENT
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3826
Practice Address - Country:US
Practice Address - Phone:502-582-7484
Practice Address - Fax:502-582-7646
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1330103TC2200X
KY130491103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100438340 (KOHMG)Medicaid
IN300001079-KOHMGMedicaid
KY890006900Medicaid
KY890006900Medicaid
KYK220720 (KOHMG)Medicare PIN
KYP66762Medicare UPIN