Provider Demographics
NPI:1588661433
Name:BECKER, ROBERT E (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:BECKER
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 1:512 MELISSA DR
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-5046
Mailing Address - Country:US
Mailing Address - Phone:215-628-8072
Mailing Address - Fax:215-628-8072
Practice Address - Street 1:512 MELISSA DR
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-5046
Practice Address - Country:US
Practice Address - Phone:215-628-8072
Practice Address - Fax:215-628-8072
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004565L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAR05994Medicare UPIN
PA88738KQBMedicare ID - Type Unspecified