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NPI Code Detail

MEDICARE: ROBERT BRUCE RISAVI LCSW

MEDICARE: ROBERT BRUCE RISAVI LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerC014347NC

General Provider Information

NPI Number : 1144530940
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT BRUCE RISAVI LCSW
Provider Business Mailing Address
First Line : 7490 WATERSIDE CROSSING BLVD STE 2A
Second Line :
City : DENVER
State : NC
Zip : 28037-3004
Country : US
Telephone Number : 704-360-3637
Fax Number :
Provider Business Practice Location Address
First Line : 7490 WATERSIDE CROSSING BLVD STE 2A
Second Line :
City : DENVER
State : NC
Zip : 28037-3004
Country : US
Telephone Number : 704-360-3637
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2010
Last Update Date : 01/09/2026

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