Provider Demographics
NPI:1881638815
Name:KINNEAR, ROBERT C (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:KINNEAR
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 1:9510 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-9639
Mailing Address - Country:US
Mailing Address - Phone:317-898-7446
Mailing Address - Fax:
Practice Address - Street 1:9510 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46239-9639
Practice Address - Country:US
Practice Address - Phone:317-898-7446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001098A101YM0800X
IN34001642A1041C0700X
IN35000874A106H00000X
IN28169390A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200042460Medicaid
IN200042460Medicaid