Provider Demographics
NPI:1164703567
Name:SMOLA, ROBERT DAVID (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DAVID
Last Name:SMOLA
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1859 BUCKINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-4268
Mailing Address - Country:US
Mailing Address - Phone:708-574-8980
Mailing Address - Fax:708-680-3122
Practice Address - Street 1:1600 WESTCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-4362
Practice Address - Country:US
Practice Address - Phone:708-574-8980
Practice Address - Fax:708-680-3122
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0094771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical