Provider Demographics
NPI:1326032038
Name:AZRAK, ROBERT (EDD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:AZRAK
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 STANTON ST
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:MA
Mailing Address - Zip Code:02370-1824
Mailing Address - Country:US
Mailing Address - Phone:617-872-2368
Mailing Address - Fax:781-898-9508
Practice Address - Street 1:48 STANTON ST
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:MA
Practice Address - Zip Code:02370-1824
Practice Address - Country:US
Practice Address - Phone:617-872-2368
Practice Address - Fax:781-898-9508
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2239103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0518743Medicaid
MA0518743Medicaid