Provider Demographics
NPI:1063018257
Name:SLAVIN, ROBIN L (LICSW)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:L
Last Name:SLAVIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-2128
Mailing Address - Country:US
Mailing Address - Phone:781-346-1628
Mailing Address - Fax:
Practice Address - Street 1:15 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-2128
Practice Address - Country:US
Practice Address - Phone:781-346-1628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA113433-SW-LICSW101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty