Provider Demographics
NPI:1982673729
Name:MOHR, ROBERT THEODORE (LCSW MSW BCDR)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:THEODORE
Last Name:MOHR
Suffix:
Gender:M
Credentials:LCSW MSW BCDR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 MAIN STREET
Mailing Address - Street 2:STE 201
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1751
Mailing Address - Country:US
Mailing Address - Phone:631-261-8804
Mailing Address - Fax:631-261-8805
Practice Address - Street 1:256 MAIN STREET
Practice Address - Street 2:STE 201
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-1751
Practice Address - Country:US
Practice Address - Phone:631-261-8804
Practice Address - Fax:631-261-8805
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO121611104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0017766OtherGHI
NY60054OtherAETNA
NY065242OtherVALUE OPTIONS
NY60054OtherAETNA