Provider Demographics
NPI:1093751208
Name:LASKY, ROBERT G (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:LASKY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1307
Mailing Address - Country:US
Mailing Address - Phone:781-248-8357
Mailing Address - Fax:781-659-2419
Practice Address - Street 1:639 GRANITE ST
Practice Address - Street 2:SUITE LL15
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-5366
Practice Address - Country:US
Practice Address - Phone:781-248-8357
Practice Address - Fax:781-659-2419
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA777103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0502057Medicaid
MA0502057Medicaid