Provider Demographics
NPI:1417060708
Name:WILLIAMS, ROBERT STANLEY JR (EDD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:STANLEY
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COHASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02025-1343
Mailing Address - Country:US
Mailing Address - Phone:781-383-6954
Mailing Address - Fax:617-328-4341
Practice Address - Street 1:59 CODDINGTON ST
Practice Address - Street 2:SUITE 203
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4510
Practice Address - Country:US
Practice Address - Phone:617-328-4348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3105103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0511633Medicaid
MAWO3201Medicare UPIN
MAWO3201-68Medicare ID - Type Unspecified