Provider Demographics
NPI:1619030897
Name:AMOS, ROBERT A (LICSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:A
Last Name:AMOS
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 DEVEREAUX ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-8113
Mailing Address - Country:US
Mailing Address - Phone:781-608-6831
Mailing Address - Fax:888-971-4291
Practice Address - Street 1:1234 BROADWAY
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-1703
Practice Address - Country:US
Practice Address - Phone:781-608-6831
Practice Address - Fax:888-971-4291
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1107721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical