Provider Demographics
NPI:1942585781
Name:BROWN, ROBERT R (PHD, LICSW, LADAC-1)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:R
Last Name:BROWN
Suffix:
Gender:M
Credentials:PHD, LICSW, LADAC-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MOUNT IDA RD
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-1709
Mailing Address - Country:US
Mailing Address - Phone:617-288-1584
Mailing Address - Fax:617-288-8881
Practice Address - Street 1:25 MOUNT IDA RD
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-1709
Practice Address - Country:US
Practice Address - Phone:617-288-1584
Practice Address - Fax:617-288-8881
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)