Basic Information
| Provider Information | |||||||||
| NPI: | 1114452497 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRAINUM | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| OtherLastName: | TRAINUM | ||||||||
| OtherFirstName: | BOBBY | ||||||||
| OtherMiddleName: | MICHAEL | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 32 PARK ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | ADAMS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012202085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606058604 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 61 EAGLE ST | ||||||||
| Address2: | |||||||||
| City: | PITTSFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012014714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4134182300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2017 | ||||||||
| LastUpdateDate: | 04/25/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.