Provider Demographics
NPI:1033448113
Name:OUIMETTE, ROBERT (LMSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:OUIMETTE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 N 7TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-3653
Mailing Address - Country:US
Mailing Address - Phone:602-279-7655
Mailing Address - Fax:
Practice Address - Street 1:1255 W BASELINE RD
Practice Address - Street 2:SUITE B-258
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-5820
Practice Address - Country:US
Practice Address - Phone:480-296-0346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2014-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-13206101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health