Provider Demographics
NPI:1871657296
Name:ZEVIN, ROBERT N (EDD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:N
Last Name:ZEVIN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 DAVIS AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-1925
Mailing Address - Country:US
Mailing Address - Phone:617-065-9757
Mailing Address - Fax:
Practice Address - Street 1:57 DAVIS AVE
Practice Address - Street 2:
Practice Address - City:WEST NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02465-1925
Practice Address - Country:US
Practice Address - Phone:617-065-9757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3086103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3086OtherSTATE PSYCHOLOGY LICENSE