Provider Demographics
NPI:1649910068
Name:MUGERA, ROBERT (LSW)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MUGERA
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 WILLIAMSBURY DR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-3805
Mailing Address - Country:US
Mailing Address - Phone:224-489-5810
Mailing Address - Fax:
Practice Address - Street 1:1301 PYOTT RD STE 208A
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-9798
Practice Address - Country:US
Practice Address - Phone:224-214-0738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.107034104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker