Provider Demographics
NPI:1477529105
Name:VALENTINE, ROBERT M (MSW, LCSW, CADC III)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:M
Last Name:VALENTINE
Suffix:
Gender:M
Credentials:MSW, LCSW, CADC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 HALL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-1656
Mailing Address - Country:US
Mailing Address - Phone:715-732-7760
Mailing Address - Fax:
Practice Address - Street 1:2500 HALL AVE STE A
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-1656
Practice Address - Country:US
Practice Address - Phone:715-732-7760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI947-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39569000Medicaid
WI888670001Medicare PIN