Provider Demographics
NPI:1225329493
Name:VANDERCOOK, ROBERT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:VANDERCOOK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-2620
Mailing Address - Country:US
Mailing Address - Phone:856-630-7450
Mailing Address - Fax:
Practice Address - Street 1:610 KINGS HWY
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-2620
Practice Address - Country:US
Practice Address - Phone:856-630-7450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016986103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical