Provider Demographics
NPI:1558349878
Name:PRUE, ROBERT E (LCSW)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:PRUE
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 1:3642 CHARLOTTE ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64109-2636
Mailing Address - Country:US
Mailing Address - Phone:816-830-6127
Mailing Address - Fax:
Practice Address - Street 1:3642 CHARLOTTE ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64109-2636
Practice Address - Country:US
Practice Address - Phone:816-561-4481
Practice Address - Fax:816-561-4481
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW-17121041C0700X
MOLCSW-0053661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0009822Medicare ID - Type UnspecifiedMEDICARE OF KS/NW MO