Provider Demographics
NPI:1407111784
Name:HYLAND, ROBIN (LADC)
Entity Type:Individual
Prefix:MISS
First Name:ROBIN
Middle Name:
Last Name:HYLAND
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 QUABOAG ST
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01506-2808
Mailing Address - Country:US
Mailing Address - Phone:508-867-9667
Mailing Address - Fax:
Practice Address - Street 1:134 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:MA
Practice Address - Zip Code:01562-2155
Practice Address - Country:US
Practice Address - Phone:508-867-9667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2253101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)