Provider Demographics
NPI:1114202439
Name:WENERT, ROBERT OLIVER (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:OLIVER
Last Name:WENERT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DORTHA AVE
Mailing Address - Street 2:AWARENESS & DISCOVERY GROUP
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-2014
Mailing Address - Country:US
Mailing Address - Phone:859-525-1487
Mailing Address - Fax:859-525-7811
Practice Address - Street 1:2 DORTHA AVE
Practice Address - Street 2:AWARENESS & DISCOVERY GROUP
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-2014
Practice Address - Country:US
Practice Address - Phone:859-525-1487
Practice Address - Fax:859-525-7811
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY50921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
12282705OtherCAQH