Provider Demographics
NPI:1669607487
Name:BARE, ROBERT LEWIS (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEWIS
Last Name:BARE
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:PO BOX 130601
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-0601
Mailing Address - Country:US
Mailing Address - Phone:205-504-2496
Mailing Address - Fax:
Practice Address - Street 1:631 BEACON PKWY W
Practice Address - Street 2:SUITE 203
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-3124
Practice Address - Country:US
Practice Address - Phone:205-504-2496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1516103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical