Provider Demographics
NPI:1093877748
Name:KITTLE, ROBERT JAMES (MSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JAMES
Last Name:KITTLE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 79 BOX 1D
Mailing Address - Street 2:
Mailing Address - City:CROWLEY LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:93546-9701
Mailing Address - Country:US
Mailing Address - Phone:760-935-4827
Mailing Address - Fax:
Practice Address - Street 1:512 W LINE ST
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-3347
Practice Address - Country:US
Practice Address - Phone:760-872-9145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS68941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical