Provider Demographics
NPI:1902015381
Name:WALTERS, ROBERT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:WALTERS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5618 NEBRASKA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-1258
Mailing Address - Country:US
Mailing Address - Phone:202-536-8046
Mailing Address - Fax:
Practice Address - Street 1:1350 CONNECTICUT AVE NW STE 205
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-1723
Practice Address - Country:US
Practice Address - Phone:202-536-8046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000517103TC0700X
NJSI03790103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC203055600OtherPSYCHOLOGIST
NJ203055600OtherPSYCHOLOGIST