Provider Demographics
NPI:1710052642
Name:ROBINSON, ALAN LEROY (MA LCSW 200877 MA MF)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:LEROY
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:MA LCSW 200877 MA MF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 ST ROSE ST
Mailing Address - Street 2:NO 1
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3907
Mailing Address - Country:US
Mailing Address - Phone:617-522-2420
Mailing Address - Fax:
Practice Address - Street 1:30 ST ROSE ST
Practice Address - Street 2:NO 1
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3907
Practice Address - Country:US
Practice Address - Phone:617-522-2420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALCSW2008771041C0700X
MAMFT363106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAR0MH0368OtherBCBS OF MA
MA200877OtherLCSW
MA363OtherMFT
MA410883OtherSECUNE HORIZON