Healthcare Provider Details

I. General information

NPI: 1144336330
Provider Name (Legal Business Name): ROBERT JOHN CARBO LCSW C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6213 ASHTON PARK COURT
COLUMBIA MD
21044-3947
US

IV. Provider business mailing address

6213 ASHTON PARK COURT
COLUMBIA MD
21044-3947
US

V. Phone/Fax

Practice location:
  • Phone: 410-964-1770
  • Fax: 410-964-1898
Mailing address:
  • Phone: 410-964-1770
  • Fax: 410-964-1898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4780
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: