Provider Demographics
NPI:1326181595
Name:ANZOLA, ROBERT C (MSW, LICSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:C
Last Name:ANZOLA
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:980 MAIN ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:OSTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02655-2045
Mailing Address - Country:US
Mailing Address - Phone:508-732-3000
Mailing Address - Fax:508-746-3224
Practice Address - Street 1:40 INDUSTRIAL PARK RD
Practice Address - Street 2:D.M.H.
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4884
Practice Address - Country:US
Practice Address - Phone:508-732-3000
Practice Address - Fax:508-746-3224
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10249961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDAN P22538Medicare ID - Type UnspecifiedMEDICARE PART B PROVIDER