Provider Demographics
NPI:1619018934
Name:RISSO, ROBIN A (LMFT)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:A
Last Name:RISSO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2858
Mailing Address - Country:US
Mailing Address - Phone:978-256-0667
Mailing Address - Fax:978-256-5567
Practice Address - Street 1:21 GLEN AVE
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2858
Practice Address - Country:US
Practice Address - Phone:978-256-0667
Practice Address - Fax:978-256-5567
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1235106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist