Provider Demographics
NPI:1346385440
Name:DITOMASSO, ROBERT A (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:DITOMASSO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WENDEE WAY
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-3527
Mailing Address - Country:US
Mailing Address - Phone:856-881-0772
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL TOWER 255 SO. 17 STREET
Practice Address - Street 2:SUITE 2708
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103
Practice Address - Country:US
Practice Address - Phone:215-735-2444
Practice Address - Fax:215-735-2447
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00200900103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist