Provider Demographics
NPI:1891708061
Name:HOSPERS, ROBERT CONCANNEN (LCSW CASAC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CONCANNEN
Last Name:HOSPERS
Suffix:
Gender:M
Credentials:LCSW CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SAREDON PLACE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606
Mailing Address - Country:US
Mailing Address - Phone:585-275-3600
Mailing Address - Fax:585-273-1089
Practice Address - Street 1:1 SAREDON PLACE
Practice Address - Street 2:SUITE 300
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606
Practice Address - Country:US
Practice Address - Phone:585-275-3600
Practice Address - Fax:585-273-1089
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPO483571104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02723320Medicaid
NY7616661OtherAETNA
NYIA0853Medicare ID - Type Unspecified