Healthcare Provider Details

I. General information

NPI: 1326032038
Provider Name (Legal Business Name): ROBERT AZRAK ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 01/06/2025
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 STANTON ST
ROCKLAND MA
02370-1824
US

IV. Provider business mailing address

48 STANTON ST
ROCKLAND MA
02370-1824
US

V. Phone/Fax

Practice location:
  • Phone: 617-872-2368
  • Fax: 781-871-1207
Mailing address:
  • Phone: 617-872-2368
  • Fax: 781-898-9508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2239
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: