Provider Demographics
NPI:1356515399
Name:MILES, ROBERT C (MS ED LCSW)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:MILES
Suffix:
Gender:M
Credentials:MS ED LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N3152 STATE RD. 81
Mailing Address - Street 2:GREEN COUNTY HUMAN SERVICES
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-9397
Mailing Address - Country:US
Mailing Address - Phone:608-328-9311
Mailing Address - Fax:608-328-9490
Practice Address - Street 1:N3152 STATE RD. 81
Practice Address - Street 2:GREEN COUNTY HUMAN SERVICES
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-8821
Practice Address - Country:US
Practice Address - Phone:608-328-9311
Practice Address - Fax:608-328-9490
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI904-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39615600Medicaid