Provider Demographics
NPI:1730794843
Name:CONTRERAS, ROBERTO CARLOS
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:CARLOS
Last Name:CONTRERAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7990 E SNYDER RD APT 11101
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-9022
Mailing Address - Country:US
Mailing Address - Phone:192-892-0423
Mailing Address - Fax:
Practice Address - Street 1:1014 N COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-4239
Practice Address - Country:US
Practice Address - Phone:520-214-2331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-187841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1386641124OtherLCSW-11577 DOCTOR OF BEHAVIORAL HEALTH LICENSED CLINICAL SOCIAL WORKER