Provider Demographics
NPI:1124263223
Name:SABINO, JOHN ROBERT (LICSW)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:SABINO
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7582 CURRELL BLVD
Mailing Address - Street 2:STE 208
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2262
Mailing Address - Country:US
Mailing Address - Phone:651-739-7539
Mailing Address - Fax:651-730-9200
Practice Address - Street 1:7582 CURRELL BLVD
Practice Address - Street 2:STE 208
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2262
Practice Address - Country:US
Practice Address - Phone:651-739-7539
Practice Address - Fax:651-730-9200
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN152721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN190157500Medicaid
MN#800001590Medicare UPIN