Provider Demographics
NPI:1740305465
Name:SILLS, ROBERT O (PHD, LICSW)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:O
Last Name:SILLS
Suffix:
Gender:M
Credentials:PHD, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 HIGHLAND AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2530
Mailing Address - Country:US
Mailing Address - Phone:617-666-5800
Mailing Address - Fax:617-666-5832
Practice Address - Street 1:403 HIGHLAND AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2530
Practice Address - Country:US
Practice Address - Phone:617-666-5800
Practice Address - Fax:617-666-5832
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1044681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1898396Medicaid
MAP02534Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID