Provider Demographics
NPI:1396853560
Name:LIMONCELLI, ROBERT J (MSW, LICSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:LIMONCELLI
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:J
Other - Last Name:LIMONCELLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:22 SPEAR ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4514
Mailing Address - Country:US
Mailing Address - Phone:617-472-5428
Mailing Address - Fax:617-847-4450
Practice Address - Street 1:22 SPEAR ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4514
Practice Address - Country:US
Practice Address - Phone:617-472-5428
Practice Address - Fax:617-847-4450
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1035361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical