Provider Demographics
NPI:1336739622
Name:RICKLE, ROBERT B JR (LCSW)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:RICKLE
Suffix:JR
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 1:415 W MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-4644
Mailing Address - Country:US
Mailing Address - Phone:575-956-8698
Mailing Address - Fax:
Practice Address - Street 1:2039 COTTAGE SAN RD
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-8968
Practice Address - Country:US
Practice Address - Phone:575-956-8698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-109251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical