Provider Demographics
NPI:1013998293
Name:WHITNEY, ROBERT (MSW, ACSW, LCSW)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:WHITNEY
Suffix:
Gender:M
Credentials:MSW, ACSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8147 E AUTUMN SAGE TRL
Mailing Address - Street 2:
Mailing Address - City:GOLD CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:85218-1993
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1423 S HIGLEY RD
Practice Address - Street 2:SUITE 112
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3429
Practice Address - Country:US
Practice Address - Phone:480-654-0992
Practice Address - Fax:480-325-5444
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW09461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
70249Medicare ID - Type Unspecified