Healthcare Provider Details

I. General information

NPI: 1871260695
Provider Name (Legal Business Name): ROBERT TITUS, LMHC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2021
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E WASHINGTON ST UNIT 47
NORTH ATTLEBORO MA
02760-6324
US

IV. Provider business mailing address

500 E WASHINGTON ST UNIT 47
NORTH ATTLEBORO MA
02760-6324
US

V. Phone/Fax

Practice location:
  • Phone: 774-266-0174
  • Fax: 508-213-3908
Mailing address:
  • Phone: 774-266-0174
  • Fax: 508-213-3908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT D TITUS
Title or Position: OWNER
Credential: LMHC
Phone: 774-266-0174