Provider Demographics
NPI:1417642778
Name:CRAVENS, ROBERT EDWARD
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:EDWARD
Last Name:CRAVENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 DARTMOUTH DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2218
Mailing Address - Country:US
Mailing Address - Phone:505-333-9042
Mailing Address - Fax:
Practice Address - Street 1:120 DARTMOUTH DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2218
Practice Address - Country:US
Practice Address - Phone:505-333-9042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical