Provider Demographics
NPI:1063002327
Name:CONTI, ROBERT PAUL JR
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:PAUL
Last Name:CONTI
Suffix:JR
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 1:800 W WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-2472
Mailing Address - Country:US
Mailing Address - Phone:502-409-7181
Mailing Address - Fax:
Practice Address - Street 1:800 W WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-2472
Practice Address - Country:US
Practice Address - Phone:502-409-7181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician