Provider Demographics
NPI: | 1700096732 |
---|---|
Name: | HROBAK, AMY (MSW, LICSW) |
Entity Type: | Individual |
Prefix: | MS |
First Name: | AMY |
Middle Name: | |
Last Name: | HROBAK |
Suffix: | |
Gender: | F |
Credentials: | MSW, LICSW |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 31 HEATH ST |
Mailing Address - Street 2: | |
Mailing Address - City: | JAMAICA PLAIN |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 02130-1650 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 617-523-6400 |
Mailing Address - Fax: | 617-523-3034 |
Practice Address - Street 1: | 31 HEATH ST |
Practice Address - Street 2: | |
Practice Address - City: | JAMAICA PLAIN |
Practice Address - State: | MA |
Practice Address - Zip Code: | 02130-1650 |
Practice Address - Country: | US |
Practice Address - Phone: | 617-523-6400 |
Practice Address - Fax: | 617-523-3034 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2007-05-22 |
Last Update Date: | 2021-11-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
101YM0800X | ||
MA | 117963 | 1041C0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MA | 117963 | Other | LICENSED INDEPENDENT CLINICAL SOCIAL WORKER |
MA | 1303414 | Medicaid |