Provider Demographics
NPI:1093742298
Name:HENSLEY, ROBERT M (LMSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:HENSLEY
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 1:35 W HURON ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-2120
Mailing Address - Country:US
Mailing Address - Phone:248-745-4900
Mailing Address - Fax:248-745-6872
Practice Address - Street 1:35 W HURON ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2120
Practice Address - Country:US
Practice Address - Phone:248-745-4900
Practice Address - Fax:248-745-6872
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010342691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N76320002Medicare UPIN