Healthcare Provider Details

I. General information

NPI: 1235395419
Provider Name (Legal Business Name): ROBERT KYLE BIVENS LCSW-C , LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 08/21/2020
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 SOLAREX CT SUITE 201
FREDERICK MD
21703-7005
US

IV. Provider business mailing address

113 MADISON ST NW
WASHINGTON DC
20011-2311
US

V. Phone/Fax

Practice location:
  • Phone: 301-663-8263
  • Fax: 301-682-5326
Mailing address:
  • Phone: 202-750-1246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13462
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50079737
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: