Provider Demographics
NPI:1487409397
Name:MOCK, ROBERT LINCOLN (LCSW)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LINCOLN
Last Name:MOCK
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 1:7327 N MANNING DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-1917
Mailing Address - Country:US
Mailing Address - Phone:720-985-4311
Mailing Address - Fax:
Practice Address - Street 1:7327 N MANNING DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-1917
Practice Address - Country:US
Practice Address - Phone:720-985-4311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0267541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical