Provider Demographics
NPI:1790857332
Name:JONES, ROBERT JOHN (MSW LICSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JOHN
Last Name:JONES
Suffix:
Gender:M
Credentials: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:PO BOX 650
Mailing Address - Street 2:45 SO ORLEANS RD
Mailing Address - City:ORLEANS
Mailing Address - State:MA
Mailing Address - Zip Code:02653
Mailing Address - Country:US
Mailing Address - Phone:508-255-4293
Mailing Address - Fax:508-255-8951
Practice Address - Street 1:45 SO ORLEANS RD
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653
Practice Address - Country:US
Practice Address - Phone:508-255-4293
Practice Address - Fax:508-255-8951
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1016697104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
762420OtherTUFTS
P04783OtherBCBS
MAP04783Medicare ID - Type Unspecified