Healthcare Provider Details

I. General information

NPI: 1104827559
Provider Name (Legal Business Name): ROBERT C CROSS ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 BOSTON ST SUITE 306
LYNN MA
01904-3137
US

IV. Provider business mailing address

5 BABSON ST UNIT 3
GLOUCESTER MA
01930-3604
US

V. Phone/Fax

Practice location:
  • Phone: 617-362-3139
  • Fax: 781-592-3796
Mailing address:
  • Phone: 978-282-7452
  • Fax: 781-598-8137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4068
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: