Provider Demographics
NPI:1497192363
Name:COUNSELING AND ASSESSMENT SERVICES
Entity Type:Organization
Organization Name:COUNSELING AND ASSESSMENT SERVICES
Other - Org Name:ROBERT R. IDDINGS, PH.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:IDDINGS
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:814-490-4740
Mailing Address - Street 1:1363 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-2559
Mailing Address - Country:US
Mailing Address - Phone:814-490-4740
Mailing Address - Fax:814-455-0754
Practice Address - Street 1:1363 W 6TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-2559
Practice Address - Country:US
Practice Address - Phone:814-490-4740
Practice Address - Fax:814-455-0754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005995101YP2500X
PAPS016557L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026954840001Medicaid