| Doctor Name: | MR. ROBERT J. FETTIG |
| NPI Number: | 1013132497 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LICSW |
| License Number: | 110208 |
| Business Practice Address: | 180 Morton St Jamaica Plain, MA - 021303735 |
| Business Phone Number: | 6176269553 |
| Business Fax Number: | 6176269578 |
| Mailing Address: | 180 Morton St, JAMAICA PLAIN |
| State: | MA |
| Postal Code: | 021303735 |
| Phone Number: | 6176269553 |
| Fax Number: | 6176269578 |
| NPI Enumeration Date: | 04/13/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 110208 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |