Provider Demographics
NPI:1194822239
Name:MARKOVIC, ROBERT (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:MARKOVIC
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 1:627 N LARCHMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-1307
Mailing Address - Country:US
Mailing Address - Phone:310-652-7392
Mailing Address - Fax:
Practice Address - Street 1:627 N LARCHMONT BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-1307
Practice Address - Country:US
Practice Address - Phone:310-652-7392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS13680104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW13680Medicare ID - Type Unspecified