Healthcare Provider Details

I. General information

NPI: 1942272760
Provider Name (Legal Business Name): ROBERT E CRAIG-COMIN MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 TURNPIKE ST SUITE #81
N ANDOVER MA
01845-5922
US

IV. Provider business mailing address

PO BOX 4175
ANDOVER MA
01810-0813
US

V. Phone/Fax

Practice location:
  • Phone: 978-749-2720
  • Fax: 978-470-0804
Mailing address:
  • Phone: 978-749-2720
  • Fax: 978-470-0804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number106238
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: