Healthcare Provider Details

I. General information

NPI: 1962770925
Provider Name (Legal Business Name): ROBERT CONLON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 COUNTY RD
POCASSET MA
02559-2110
US

IV. Provider business mailing address

830 COUNTY RD
POCASSET MA
02559-2110
US

V. Phone/Fax

Practice location:
  • Phone: 508-564-9690
  • Fax:
Mailing address:
  • Phone: 508-564-9690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number119004
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: