Provider Demographics
NPI:1508912650
Name:DEANE, ROBERT WINTHROP (LPCC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WINTHROP
Last Name:DEANE
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2442 CERRILLOS RD
Mailing Address - Street 2:PMB 268
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-3262
Mailing Address - Country:US
Mailing Address - Phone:505-670-3202
Mailing Address - Fax:
Practice Address - Street 1:2871 CLARK CT
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-5179
Practice Address - Country:US
Practice Address - Phone:505-670-3202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0077991101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health