Provider Demographics
NPI:1124156021
Name:MUNYON, ROBERT ALLEN (LCSW)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALLEN
Last Name:MUNYON
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 1:123 DIXON RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-2133
Mailing Address - Country:US
Mailing Address - Phone:518-798-2088
Mailing Address - Fax:
Practice Address - Street 1:123 DIXON RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-2133
Practice Address - Country:US
Practice Address - Phone:518-798-2088
Practice Address - Fax:518-798-2088
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR046170-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03769853Medicaid
NY03769853Medicaid