Provider Demographics
NPI:1417926197
Name:PETRUZZI, ROBERT PETER (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PETER
Last Name:PETRUZZI
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 1:1489 BALTIMORE PIKE
Mailing Address - Street 2:BLDG. 200, SUITE 250
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-3958
Mailing Address - Country:US
Mailing Address - Phone:610-544-2110
Mailing Address - Fax:610-604-9510
Practice Address - Street 1:1489 BALTIMORE PIKE
Practice Address - Street 2:BLDG. 200, SUITE 250
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-3958
Practice Address - Country:US
Practice Address - Phone:610-544-2110
Practice Address - Fax:610-604-9510
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003470-L103TB0200X, 103TC1900X, 103TF0000X, 103TM1800X, 103T00000X, 103TP2701X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool