Provider Demographics
NPI:1336232107
Name:ROBBINS, PETER G (EDD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:G
Last Name:ROBBINS
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 1:1853 COMMONWEALTH AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135
Mailing Address - Country:US
Mailing Address - Phone:617-254-3410
Mailing Address - Fax:
Practice Address - Street 1:1853 COMMONWEALTH AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135
Practice Address - Country:US
Practice Address - Phone:617-254-3410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3007103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW03073OtherBLUE SHIELD
MAW03073OtherBLUE SHIELD