Provider Demographics
NPI:1083660740
Name:MALTZ GROSS, ROBYN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:ROBYN
Middle Name:
Last Name:MALTZ GROSS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ROBYN
Other - Middle Name:
Other - Last Name:MALTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:399 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-2232
Mailing Address - Country:US
Mailing Address - Phone:857-231-2219
Mailing Address - Fax:
Practice Address - Street 1:399 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:MA
Practice Address - Zip Code:02466-2232
Practice Address - Country:US
Practice Address - Phone:857-231-2219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1076651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP22223Medicaid