Provider Demographics
NPI:1336519339
Name:O'LOUGHLIN, ROBERT
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:O'LOUGHLIN
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 1:2 SAINT PAUL ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-2506
Mailing Address - Country:US
Mailing Address - Phone:617-547-0198
Mailing Address - Fax:
Practice Address - Street 1:2 SAINT PAUL ST
Practice Address - Street 2:UNIT 2
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-2506
Practice Address - Country:US
Practice Address - Phone:617-547-0198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker