Provider Demographics
NPI:1972908986
Name:CROOK, ROBERT A III (MSW, LSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:A
Last Name:CROOK
Suffix:III
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 EAST US ROUTE 36
Mailing Address - Street 2:SUITE A
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078
Mailing Address - Country:US
Mailing Address - Phone:937-653-5583
Mailing Address - Fax:937-653-4787
Practice Address - Street 1:1522 EAST US ROUTE 36
Practice Address - Street 2:SUITE A
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078
Practice Address - Country:US
Practice Address - Phone:937-653-5583
Practice Address - Fax:937-653-4787
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-03
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS. 1450525104100000X
OHI.1700221104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker