Provider Demographics
NPI:1053413328
Name:ANDERSON, ROBERT GEOFFREY (MSW, LCSW-C)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:GEOFFREY
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9816 GUNFORGE RD
Mailing Address - Street 2:
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128-9535
Mailing Address - Country:US
Mailing Address - Phone:410-529-2980
Mailing Address - Fax:
Practice Address - Street 1:2510 SAINT PAUL ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-4760
Practice Address - Country:US
Practice Address - Phone:410-467-6600
Practice Address - Fax:410-467-7277
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD051991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC0328455Medicare ID - Type Unspecified