Healthcare Provider Details

I. General information

NPI: 1720078785
Provider Name (Legal Business Name): ROBERT LOUIS NUTT MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 WASHINGTON ST BLDG D
NORWELL MA
02061-1740
US

IV. Provider business mailing address

80 WASHINGTON ST BLDG D
NORWELL MA
02061-1740
US

V. Phone/Fax

Practice location:
  • Phone: 781-871-2212
  • Fax: 781-871-2225
Mailing address:
  • Phone: 781-871-2212
  • Fax: 781-871-2225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1020769
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: