Provider Demographics
NPI:1396902003
Name:ROBINSON, GARY L (MSW APSW)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:L
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:MSW APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 S 84TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53214-1456
Mailing Address - Country:US
Mailing Address - Phone:414-476-3710
Mailing Address - Fax:414-778-5985
Practice Address - Street 1:151 S 84TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-1456
Practice Address - Country:US
Practice Address - Phone:414-476-3710
Practice Address - Fax:414-778-5985
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI126471-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41002100Medicaid
WI126471-121OtherAPSW