Provider Demographics
NPI:1437550415
Name:FROST, ROBERT BROCK (PHD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BROCK
Last Name:FROST
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 1:3400 CONSTITUTION AVE NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1242
Mailing Address - Country:US
Mailing Address - Phone:801-589-0043
Mailing Address - Fax:
Practice Address - Street 1:3400 CONSTITUTION AVE NE
Practice Address - Street 2:SUITE C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-1242
Practice Address - Country:US
Practice Address - Phone:801-589-0043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPSY1341103G00000X
NM1341103G00000X
NMPSY-RXC0081103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist