MEDICARE: MR. ROBERT A AMOS LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	110772	MA

General Provider Information

NPI Number	:	1619030897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT A AMOS LICSW

Provider Business Mailing Address
First Line	:	17 DEVEREAUX ST
Second Line	:
City	:	ARLINGTON
State	:	MA
Zip	:	02476-8113
Country	:	US
Telephone Number	:	781-608-6831
Fax Number	:	888-971-4291

Provider Business Practice Location Address
First Line	:	1234 BROADWAY
Second Line	:
City	:	SOMERVILLE
State	:	MA
Zip	:	02144-1703
Country	:	US
Telephone Number	:	781-608-6831
Fax Number	:	888-971-4291

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	02/12/2019

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