Healthcare Provider Details

I. General information

NPI: 1124260328
Provider Name (Legal Business Name): ROBERT MCINTOSH MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 SPRING ST
JEFFERSONVILLE IN
47130-3452
US

IV. Provider business mailing address

303 CASTLEVIEW DR
LOUISVILLE KY
40207-2260
US

V. Phone/Fax

Practice location:
  • Phone: 812-280-2080
  • Fax:
Mailing address:
  • Phone: 502-409-4662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: