Provider Demographics
NPI:1093786824
Name:DIGIACOMO, ROBERT JAMES (MA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JAMES
Last Name:DIGIACOMO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S CHESTER RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382
Mailing Address - Country:US
Mailing Address - Phone:610-399-1726
Mailing Address - Fax:
Practice Address - Street 1:1515 WEST CHESTER PIKE
Practice Address - Street 2:STE D2
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382
Practice Address - Country:US
Practice Address - Phone:610-692-2092
Practice Address - Fax:610-692-2863
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003402L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPS003402LOtherLICENSE NUMBER