Provider Demographics
NPI:1093937120
Name:KING, R ROBERT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:R
Middle Name:ROBERT
Last Name:KING
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:234 S BRYN MAWR AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-2133
Mailing Address - Country:US
Mailing Address - Phone:610-525-0390
Mailing Address - Fax:610-525-4552
Practice Address - Street 1:234 S BRYN MAWR AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-2133
Practice Address - Country:US
Practice Address - Phone:610-525-0390
Practice Address - Fax:610-525-4552
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006138L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical