Provider Demographics
NPI:1629455787
Name:HALEY, ROBERT SR (LSW,LICDC-CS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:HALEY
Suffix:SR
Gender:M
Credentials:LSW,LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1856 SUNSET AVE
Mailing Address - Street 2:118
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-3160
Mailing Address - Country:US
Mailing Address - Phone:513-652-9836
Mailing Address - Fax:
Practice Address - Street 1:1856 SUNSET AVE
Practice Address - Street 2:118
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-3160
Practice Address - Country:US
Practice Address - Phone:513-652-9836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-28
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH031146101YA0400X
OH1302752104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)