MEDICARE: MR. ROBERT EARL CENCI

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
1	1041C0700X	Clinical Social Worker	6801010835	MI

General Provider Information

NPI Number	:	1972619278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT EARL CENCI

Provider Business Mailing Address
First Line	:	3271 RACQUET CLUB DR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-4770
Country	:	US
Telephone Number	:	231-932-9720
Fax Number	:	231-995-9302

Provider Business Practice Location Address
First Line	:	3271 RACQUET CLUB DR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-4770
Country	:	US
Telephone Number	:	231-932-9720
Fax Number	:	231-995-9302

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/08/2007

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