Provider Demographics
NPI:1700954005
Name:VUCINOVICH, ROBERT K (MSLP)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:K
Last Name:VUCINOVICH
Suffix:
Gender:M
Credentials:MSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:80 HAMPSHIRE AVE N
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4923
Mailing Address - Country:US
Mailing Address - Phone:612-889-4291
Mailing Address - Fax:763-546-8189
Practice Address - Street 1:80 HAMPSHIRE AVE N
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4923
Practice Address - Country:US
Practice Address - Phone:612-889-4291
Practice Address - Fax:763-546-8189
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1141103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN62-57935OtherUNITED BEHAVIORAL HEALTH
MN330J6VUOtherBLUECROSS