Provider Demographics
NPI:1659663151
Name:SIMS, ROBERT J III
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:SIMS
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 ALDEN AVE
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-1721
Mailing Address - Country:US
Mailing Address - Phone:978-219-1556
Mailing Address - Fax:978-740-9145
Practice Address - Street 1:44 ALDEN AVE
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-1721
Practice Address - Country:US
Practice Address - Phone:978-219-1556
Practice Address - Fax:978-740-9145
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator