Provider Demographics
NPI:1457421398
Name:STADOLNIK, ROBERT (EDD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:STADOLNIK
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 1:470 WASHINGTON ST
Mailing Address - Street 2:SUITE 22
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-2337
Mailing Address - Country:US
Mailing Address - Phone:781-762-8815
Mailing Address - Fax:781-769-1016
Practice Address - Street 1:470 WASHINGTON ST
Practice Address - Street 2:SUITE 22
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-2337
Practice Address - Country:US
Practice Address - Phone:781-762-8815
Practice Address - Fax:781-769-1016
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6574103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent