Provider Demographics
NPI:1194832097
Name:SNOW, ROBERT J (PHD,)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:SNOW
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 1:3811 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2340
Mailing Address - Country:US
Mailing Address - Phone:410-889-9404
Mailing Address - Fax:410-889-3616
Practice Address - Street 1:2 W 39TH ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-1701
Practice Address - Country:US
Practice Address - Phone:410-889-9404
Practice Address - Fax:410-889-3616
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD72951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD52600802OtherCAREFIRST BCBS
MD073SMedicare ID - Type Unspecified