Provider Demographics
NPI:1760978282
Name:SMITH, ROBERT R (PH D)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
Last Name:SMITH
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 TALL OAKS DR UNIT H
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-3552
Mailing Address - Country:US
Mailing Address - Phone:617-417-6899
Mailing Address - Fax:
Practice Address - Street 1:159 TALL OAKS DR UNIT H
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-3552
Practice Address - Country:US
Practice Address - Phone:617-417-6899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3371103TA0400X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)