Provider Demographics
NPI:1407069933
Name:THIEMANN, ROBERT WALTER (MSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WALTER
Last Name:THIEMANN
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 1:2742 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-1204
Mailing Address - Country:US
Mailing Address - Phone:717-232-5133
Mailing Address - Fax:
Practice Address - Street 1:3940 LOCUST LN
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-4023
Practice Address - Country:US
Practice Address - Phone:800-245-7277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW005922E1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical