Provider Demographics
NPI:1124495965
Name:WILLIAMS, ROBERT
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 NORTHAMPTON ST
Mailing Address - Street 2:#408
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02118-1861
Mailing Address - Country:US
Mailing Address - Phone:857-212-1172
Mailing Address - Fax:
Practice Address - Street 1:11 ROXBURY STREET
Practice Address - Street 2:2ND FLOOR, PYRAMID BUILDERS
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-516-0280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health