Provider Demographics
NPI:1538146204
Name:PAULY, ROBERT FRANCIS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:FRANCIS
Last Name:PAULY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NE 54TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-4389
Mailing Address - Country:US
Mailing Address - Phone:816-268-8501
Mailing Address - Fax:816-452-5700
Practice Address - Street 1:200 NE 54TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-4389
Practice Address - Country:US
Practice Address - Phone:816-268-8501
Practice Address - Fax:816-452-5700
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLCSW 0059641041C0700X
KSLSCSW 17571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000D045Medicare ID - Type Unspecified