Provider Demographics
NPI:1215094735
Name:NAZZARO, ROBERT ANTHONY JR (MSW LICSW)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ANTHONY
Last Name:NAZZARO
Suffix:JR
Gender:M
Credentials:MSW LICSW
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Mailing Address - Street 1:99 WALNUT ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-1980
Mailing Address - Country:US
Mailing Address - Phone:617-791-4805
Mailing Address - Fax:978-851-6684
Practice Address - Street 1:155 KENDALL RD
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-1361
Practice Address - Country:US
Practice Address - Phone:617-791-4805
Practice Address - Fax:978-851-6684
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1110181041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP2287401Medicare UPIN