Provider Demographics
NPI:1801412259
Name:ROBERT BLACKGROVE, PSY.D. LLC
Entity Type:Organization
Organization Name:ROBERT BLACKGROVE, PSY.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:305-964-5921
Mailing Address - Street 1:8305 SW 160TH ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-3642
Mailing Address - Country:US
Mailing Address - Phone:305-964-5921
Mailing Address - Fax:
Practice Address - Street 1:8305 SW 160TH ST
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-3642
Practice Address - Country:US
Practice Address - Phone:305-964-5921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty