Provider Demographics
NPI:1649407248
Name:ALLISON, ROBERTA (BOBBI) Y (MA, MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:ROBERTA (BOBBI)
Middle Name:Y
Last Name:ALLISON
Suffix:
Gender:F
Credentials:MA, MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 WOBURN ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3434
Mailing Address - Country:US
Mailing Address - Phone:781-396-0948
Mailing Address - Fax:
Practice Address - Street 1:45 FRANCIS ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6105
Practice Address - Country:US
Practice Address - Phone:617-732-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10256201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical