Healthcare Provider Details

I. General information

NPI: 1275265340
Provider Name (Legal Business Name): RYAN ROBINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 WESTSIDE DR
ACTON MA
01720-5940
US

IV. Provider business mailing address

8 WESTSIDE DR
ACTON MA
01720-5940
US

V. Phone/Fax

Practice location:
  • Phone: 508-969-1246
  • Fax:
Mailing address:
  • Phone: 508-969-1246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: