Provider Demographics
NPI:1245249895
Name:GREW, ROBERT S (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:GREW
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 1:3141 JOHN HUMPHRIES WYND
Mailing Address - Street 2:SUITE 275
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5438
Mailing Address - Country:US
Mailing Address - Phone:919-783-5431
Mailing Address - Fax:
Practice Address - Street 1:3141 JOHN HUMPHRIES WYND
Practice Address - Street 2:SUITE 275
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5438
Practice Address - Country:US
Practice Address - Phone:919-783-5431
Practice Address - Fax:919-783-6480
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC850103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC60-00661Medicaid
NC281-9799Medicare ID - Type UnspecifiedPSYCHOLOGIST