Provider Demographics
NPI:1588735112
Name:HASBROOK, ROBERT L (LISW)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:HASBROOK
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3308
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-3308
Mailing Address - Country:US
Mailing Address - Phone:505-280-3374
Mailing Address - Fax:505-794-1622
Practice Address - Street 1:2006 SOUTHERN BLVD SE
Practice Address - Street 2:SUITE 204
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-3764
Practice Address - Country:US
Practice Address - Phone:505-280-3374
Practice Address - Fax:505-994-1622
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-045471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical