Provider Demographics
NPI:1245827807
Name:WHITAKER, ROBERT (PSYD, NCSP, ABSNP)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:WHITAKER
Suffix:
Gender:M
Credentials:PSYD, NCSP, ABSNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3107 TRINITY DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-3150
Mailing Address - Country:US
Mailing Address - Phone:240-274-6963
Mailing Address - Fax:
Practice Address - Street 1:1110 BENFIELD BLVD STE J
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-2645
Practice Address - Country:US
Practice Address - Phone:240-274-6963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07089103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty