Healthcare Provider Details

I. General information

NPI: 1801160452
Provider Name (Legal Business Name): ERIC A ROBINSON SR. LCSW,LCAC,LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 BROADWAY SUITE F1
MERRILLVILLE IN
46410-8602
US

IV. Provider business mailing address

7725 BROADWAY SUITE A
MERRILLVILLE IN
46410-4731
US

V. Phone/Fax

Practice location:
  • Phone: 219-736-1000
  • Fax: 219-736-9699
Mailing address:
  • Phone: 219-736-1000
  • Fax: 219-736-9699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number99071665A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87001398A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: