Healthcare Provider Details

I. General information

NPI: 1174829691
Provider Name (Legal Business Name): ROBERT ALAN ZIBBELL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 01/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FRANKLIN COMMONS
FRAMINGHAM MA
01702-6619
US

IV. Provider business mailing address

1 FRANKLIN COMMONS
FRAMINGHAM MA
01702-6619
US

V. Phone/Fax

Practice location:
  • Phone: 508-872-6610
  • Fax: 508-302-8484
Mailing address:
  • Phone: 508-872-6610
  • Fax: 508-302-8484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number497
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: