Provider Demographics
NPI:1245676048
Name:CONRAD, ROBERT JOSEPH (LMSW)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:CONRAD
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2442 ALBERT DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-4702
Mailing Address - Country:US
Mailing Address - Phone:269-208-6243
Mailing Address - Fax:
Practice Address - Street 1:5020 E BELTLINE AVE NE STE 202
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-6869
Practice Address - Country:US
Practice Address - Phone:616-439-1866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010950031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI38-2272711OtherFED