Provider Demographics
NPI:1780765768
Name:STREETT, ROBERT M (LCSW)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:M
Last Name:STREETT
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Gender:M
Credentials:LCSW
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Mailing Address - Street 1:2153 E JOYCE BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4714
Mailing Address - Country:US
Mailing Address - Phone:479-575-9471
Mailing Address - Fax:479-587-9392
Practice Address - Street 1:706 S MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-4417
Practice Address - Country:US
Practice Address - Phone:870-425-5644
Practice Address - Fax:870-424-2201
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2010-01-05
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Provider Licenses
StateLicense IDTaxonomies
AR1768C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
55048OtherMEDICARE ID NUMBER