Healthcare Provider Details

I. General information

NPI: 1558349878
Provider Name (Legal Business Name): ROBERT E PRUE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W 39TH ST
KANSAS CITY MO
64111-2910
US

IV. Provider business mailing address

3642 CHARLOTTE ST
KANSAS CITY MO
64109-2636
US

V. Phone/Fax

Practice location:
  • Phone: 816-421-7608
  • Fax: 816-421-6493
Mailing address:
  • Phone: 816-830-6127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-005366
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: