Provider Demographics
NPI:1447316450
Name:HAAS, ROBERT J (LCSW)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:HAAS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 N 12TH ST
Mailing Address - Street 2:BLDG 29M
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-1397
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1707 N 12TH ST
Practice Address - Street 2:BLDG 29M
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-1397
Practice Address - Country:US
Practice Address - Phone:217-222-8641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
202173Medicare ID - Type Unspecified