Provider Demographics
NPI:1659929867
Name:MCCAULEY, ROBERT JOSEPH (MSW, MED, LICSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOSEPH
Last Name:MCCAULEY
Suffix:
Gender:M
Credentials:MSW, MED, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 FLORIDA AVE S STE 307
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1759
Mailing Address - Country:US
Mailing Address - Phone:952-544-6806
Mailing Address - Fax:
Practice Address - Street 1:715 FLORIDA AVE S STE 307
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-1759
Practice Address - Country:US
Practice Address - Phone:952-544-6806
Practice Address - Fax:952-545-0098
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN257051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical