Healthcare Provider Details

I. General information

NPI: 1780762757
Provider Name (Legal Business Name): ROBERT JOSEPH MAREK LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 COUNTY ST
DIGHTON MA
02715-1212
US

IV. Provider business mailing address

53 POINT ST
BERKLEY MA
02779-1910
US

V. Phone/Fax

Practice location:
  • Phone: 508-669-5554
  • Fax:
Mailing address:
  • Phone: 617-688-7658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1020670
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: