Provider Demographics
NPI:1225748940
Name:SADICARIO, ROBERT (LMSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:SADICARIO
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 1:3259 VAL TECH RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-9309
Mailing Address - Country:US
Mailing Address - Phone:229-333-7900
Mailing Address - Fax:
Practice Address - Street 1:3259 VAL TECH RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-9309
Practice Address - Country:US
Practice Address - Phone:229-333-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW005691104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker