Healthcare Provider Details

I. General information

NPI: 1093765125
Provider Name (Legal Business Name): ROBERT J NEWELL LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 PARK STREET CAPE COD HOSPITAL
HYANNIS MA
02601
US

IV. Provider business mailing address

PO BOX 283
SAGAMORE BEACH MA
02562-0283
US

V. Phone/Fax

Practice location:
  • Phone: 508-862-5566
  • Fax: 508-775-1598
Mailing address:
  • Phone: 781-856-9768
  • Fax: 508-888-3226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number111380
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: