Provider Demographics
NPI:1942360342
Name:DUWORS, ROBERT MARTIN (PHD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARTIN
Last Name:DUWORS
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 1:91 CAPTAIN CARLTONS ROAD
Mailing Address - Street 2:
Mailing Address - City:COTUIT
Mailing Address - State:MA
Mailing Address - Zip Code:02635
Mailing Address - Country:US
Mailing Address - Phone:508-420-2288
Mailing Address - Fax:508-477-9334
Practice Address - Street 1:162 HEGEMAN AVE STE 106
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-3109
Practice Address - Country:US
Practice Address - Phone:802-876-7613
Practice Address - Fax:802-876-7813
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPSY671103T00000X
VT048.0074176103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
189757OtherMAGELLAN
MAP04750OtherBCBS
MAP04750OtherBCBS