Provider Demographics
NPI:1891929360
Name:GAVIN, ROBERT MITCHELL (PHD, (ABD),)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MITCHELL
Last Name:GAVIN
Suffix:
Gender:M
Credentials:PHD, (ABD),
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 PERRY ST NE
Mailing Address - Street 2:G-1
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2550
Mailing Address - Country:US
Mailing Address - Phone:202-832-8403
Mailing Address - Fax:202-832-8403
Practice Address - Street 1:1218 PERRY ST NE
Practice Address - Street 2:G-1
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2550
Practice Address - Country:US
Practice Address - Phone:202-832-8403
Practice Address - Fax:202-832-8403
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC-1218101YA0400X, 101YP2500X
DCM1220-2005101YA0400X
DC203292101YA0400X
DC013305101YA0400X
DCPRC1218101YM0800X
DC6731101YP2500X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst