Provider Demographics
NPI:1104827559
Name:CROSS, ROBERT C (EDD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:CROSS
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
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Mailing Address - Street 1:5 BABSON ST
Mailing Address - Street 2:UNIT 3
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-3604
Mailing Address - Country:US
Mailing Address - Phone:978-282-7452
Mailing Address - Fax:781-598-8137
Practice Address - Street 1:225 BOSTON ST
Practice Address - Street 2:SUITE 306
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904-3137
Practice Address - Country:US
Practice Address - Phone:617-362-3139
Practice Address - Fax:781-592-3796
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA4068103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0517011Medicaid
MA0517011Medicaid