MEDICARE: MR. ROBERT HALEY SR. LSW.,LICDC-CS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	031146	OH
2	104100000X	Social Worker	1302752	OH

General Provider Information

NPI Number	:	1629455787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT HALEY SR. LSW.,LICDC-CS

Provider Business Mailing Address
First Line	:	1856 SUNSET AVE
Second Line	:	118
City	:	CINCINNATI
State	:	OH
Zip	:	45238-3160
Country	:	US
Telephone Number	:	513-652-9836
Fax Number	:

Provider Business Practice Location Address
First Line	:	1856 SUNSET AVE
Second Line	:	118
City	:	CINCINNATI
State	:	OH
Zip	:	45238-3160
Country	:	US
Telephone Number	:	513-652-9836
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2015
Last Update Date	:	05/03/2021

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