Provider Demographics
NPI:1013071760
Name:ADAMS, ROBERT WILLIAM (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:ADAMS
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 1:3110 FAIRVIEW DR
Mailing Address - Street 2:ROOM 114
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-2175
Mailing Address - Country:US
Mailing Address - Phone:270-926-1737
Mailing Address - Fax:270-926-1737
Practice Address - Street 1:3110 FAIRVIEW DR
Practice Address - Street 2:ROOM 114
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-2175
Practice Address - Country:US
Practice Address - Phone:270-926-1737
Practice Address - Fax:270-926-1737
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY580103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP300022969OtherMEDICARE ID-TYPE UNSPECIFIED
KYCP00031Medicare ID - Type UnspecifiedPSYCHOLOGIST