Provider Demographics
NPI:1568518272
Name:JOLLEY, ROBERT E (PHD, LICSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:JOLLEY
Suffix:
Gender:M
Credentials:PHD, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 COLRAIN RD
Mailing Address - Street 2:
Mailing Address - City:TOPSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01983-1304
Mailing Address - Country:US
Mailing Address - Phone:978-887-8397
Mailing Address - Fax:
Practice Address - Street 1:33 COLRAIN RD
Practice Address - Street 2:
Practice Address - City:TOPSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01983-1304
Practice Address - Country:US
Practice Address - Phone:978-887-8397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1002411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical