Healthcare Provider Details

I. General information

NPI: 1801815113
Provider Name (Legal Business Name): ROBERT VINCENT SHEVLIN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12647 OLIVE BLVD SUITE 600
SAINT LOUIS MO
63141-6345
US

IV. Provider business mailing address

4033 BREAKWATER DR
PORTSMOUTH VA
23703-5321
US

V. Phone/Fax

Practice location:
  • Phone: 800-325-3982
  • Fax:
Mailing address:
  • Phone: 757-483-8846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904001711
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: