Provider Demographics
NPI:1851792782
Name:ROBART, VAUGHN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:VAUGHN
Middle Name:
Last Name:ROBART
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 1:406 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62246-1605
Mailing Address - Country:US
Mailing Address - Phone:618-616-5608
Mailing Address - Fax:
Practice Address - Street 1:1404 N 5TH ST
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471-1039
Practice Address - Country:US
Practice Address - Phone:618-431-2275
Practice Address - Fax:618-431-2278
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0164991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical