Provider Demographics
NPI:1205544186
Name:HERSEY, ROBERT E (CLINICAL SOCIAL WORK)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:HERSEY
Suffix:
Gender:M
Credentials:CLINICAL SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 N HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-2414
Mailing Address - Country:US
Mailing Address - Phone:253-306-0598
Mailing Address - Fax:
Practice Address - Street 1:2717 N HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-2414
Practice Address - Country:US
Practice Address - Phone:253-306-0598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW610412031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical