Provider Demographics
NPI:1336326644
Name:DECARLO, ROBERT ANTHONY (MSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ANTHONY
Last Name:DECARLO
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 1:695 S VERMONT AVE FL 8
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-1349
Mailing Address - Country:US
Mailing Address - Phone:213-841-2863
Mailing Address - Fax:213-351-2769
Practice Address - Street 1:695 S VERMONT AVE FL 8
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-1349
Practice Address - Country:US
Practice Address - Phone:213-841-2863
Practice Address - Fax:213-351-2769
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010799291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical