Provider Demographics
NPI:1982185096
Name:COONS, ROBYN (LICSW, BCD)
Entity Type:Individual
Prefix:MS
First Name:ROBYN
Middle Name:
Last Name:COONS
Suffix:
Gender:F
Credentials:LICSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 SHRINE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01583-1930
Mailing Address - Country:US
Mailing Address - Phone:508-887-6264
Mailing Address - Fax:978-796-1079
Practice Address - Street 1:42 PATTON RD
Practice Address - Street 2:
Practice Address - City:AYER
Practice Address - State:MA
Practice Address - Zip Code:01434-3802
Practice Address - Country:US
Practice Address - Phone:978-796-1084
Practice Address - Fax:978-796-1079
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10250161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1025016OtherLICENSE INDEPENDENT CLINICAL SOCIAL WORK (LICSW)