Provider Demographics
NPI:1407062870
Name:FLECK, ROBERT R I (MED, CAGS, LMHC, LSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:R
Last Name:FLECK
Suffix:I
Gender:M
Credentials:MED, CAGS, LMHC, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 RANTOUL ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-3260
Mailing Address - Country:US
Mailing Address - Phone:978-828-9400
Mailing Address - Fax:
Practice Address - Street 1:348 RANTOUL ST
Practice Address - Street 2:SUITE 302
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-3260
Practice Address - Country:US
Practice Address - Phone:978-828-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7906101YM0800X
MA3032698104100000X
MA389185101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool