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General NPI Number Information
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NPI Number | 1851792782
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Entity Type | Individual
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Provider Name | VAUGHN ROBART LCSW
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Gender | Male
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Dates
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Enumeration Date | 09/10/2014
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Last Update Date | 09/10/2014
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Provider Practice Location Address
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Address Line | 1404 N 5TH ST
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City | VANDALIA
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State | IL
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Zip | 62471-1039
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Country | US
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Telephone | 618-431-2275
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Fax | 618-431-2278
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Provider Business Mailing Address
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Address Line | 406 S 5TH ST
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City | GREENVILLE
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State | IL
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Zip | 62246-1605
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Country | US
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Telephone | 618-616-5608
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.016499
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License Number State | IL
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