Provider Demographics
NPI:1356355416
Name:WADSWORTH, ROBERT DOMBEY (PHD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DOMBEY
Last Name:WADSWORTH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10109 KRAUSE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-6501
Mailing Address - Country:US
Mailing Address - Phone:804-751-8644
Mailing Address - Fax:804-751-0648
Practice Address - Street 1:10109 KRAUSE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-6501
Practice Address - Country:US
Practice Address - Phone:804-751-8644
Practice Address - Fax:804-751-0648
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001262103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
61-72773OtherUBH
VA7747811OtherVIRGINIA PREMIER
PVPB109775OtherAPS
0004397887OtherAETNA
243328OtherCOMPSYCH EAP
SENTARAOther085880
093091OtherANTHEM
241074OtherMHN
008003OtherVMC
P1567846OtherOXFORD
021955OtherVALUEOPTIONS
220674OtherMAMSI
243331OtherCOMPSYCH MH
258978OtherANTHEM - GROUP
702275OtherFIRST HEALTH
R17099Medicare UPIN