Healthcare Provider Details

I. General information

NPI: 1083660740
Provider Name (Legal Business Name): ROBYN MALTZ GROSS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROBYN MALTZ LICSW

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 CENTRAL ST
AUBURNDALE MA
02466-2232
US

IV. Provider business mailing address

399 CENTRAL ST
AUBURNDALE MA
02466-2232
US

V. Phone/Fax

Practice location:
  • Phone: 857-231-2219
  • Fax:
Mailing address:
  • Phone: 857-231-2219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number107665
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: