Provider Demographics
NPI:1306124177
Name:ADAMS, ROBERT DOUGLAS (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DOUGLAS
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 1:20220 CENTER RIDGE RD STE 320
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3501
Mailing Address - Country:US
Mailing Address - Phone:440-409-0307
Mailing Address - Fax:
Practice Address - Street 1:20220 CENTER RIDGE RD STE 320
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3501
Practice Address - Country:US
Practice Address - Phone:440-409-0307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008774103TC0700X
OH7567103TC0700X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist