Provider Demographics
NPI:1376009829
Name:ROBERT SOVOCOOL COUNSELING AND PSYCHOTHERAPY, PLLC
Entity Type:Organization
Organization Name:ROBERT SOVOCOOL COUNSELING AND PSYCHOTHERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOVOCOOL
Authorized Official - Suffix:JR
Authorized Official - Credentials:LICSW
Authorized Official - Phone:315-317-9626
Mailing Address - Street 1:12 GOLDEN HILL AVE
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-3041
Mailing Address - Country:US
Mailing Address - Phone:315-317-9626
Mailing Address - Fax:
Practice Address - Street 1:300 W MAIN ST BLDG B
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-2132
Practice Address - Country:US
Practice Address - Phone:315-317-9626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-20
Last Update Date:2019-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty