Healthcare Provider Details

I. General information

NPI: 1659219244
Provider Name (Legal Business Name): MR. ROBERT HALL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 NORTH AVE APT 3
ABINGTON MA
02351-1899
US

IV. Provider business mailing address

344 NORTH AVE APT 3
ABINGTON MA
02351-1899
US

V. Phone/Fax

Practice location:
  • Phone: 646-457-0264
  • Fax:
Mailing address:
  • Phone: 646-457-0264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number20760
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: