Provider Demographics
NPI:1871654285
Name:BARWICK, ROBERT LEONARD JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEONARD
Last Name:BARWICK
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:TODD
Other - Middle Name:
Other - Last Name:BARWICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:3121 FOX RUN CIR
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-7554
Mailing Address - Country:US
Mailing Address - Phone:252-527-2133
Mailing Address - Fax:252-527-1994
Practice Address - Street 1:1609 E 10TH ST
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-4103
Practice Address - Country:US
Practice Address - Phone:252-537-6799
Practice Address - Fax:252-537-6793
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1158103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107268Medicaid