Basic Information
| Provider Information | |||||||||
| NPI: | 1972908986 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CROOK | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | MSW, LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1522 EAST US ROUTE 36 | ||||||||
| Address2: | SUITE A | ||||||||
| City: | URBANA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9376535583 | ||||||||
| FaxNumber: | 9376534787 | ||||||||
| Practice Location | |||||||||
| Address1: | 1522 EAST US ROUTE 36 | ||||||||
| Address2: | SUITE A | ||||||||
| City: | URBANA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9376535583 | ||||||||
| FaxNumber: | 9376534787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2014 | ||||||||
| LastUpdateDate: | 03/24/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S. 1450525 | OH | N | Behavioral Health & Social Service Providers | Social Worker | 104100000X | I.1700221 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.