Provider Demographics
NPI:1902912306
Name:NOBLE, ROBERT DWIGHT (EDD)
Entity type:Individual
Prefix:PROF
First Name:ROBERT
Middle Name:DWIGHT
Last Name:NOBLE
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 N UPPER BIRDIE GALYAN RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-9230
Mailing Address - Country:US
Mailing Address - Phone:812-339-5068
Mailing Address - Fax:
Practice Address - Street 1:839 S AUTO MALL RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-5484
Practice Address - Country:US
Practice Address - Phone:812-334-1131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35000158A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist