Provider Demographics
NPI:1639392327
Name:ECKARDT, ROBERT NICHOLSON JR (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:NICHOLSON
Last Name:ECKARDT
Suffix:JR
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:PO BOX 238
Mailing Address - Street 2:4446 RT 27
Mailing Address - City:KINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08528
Mailing Address - Country:US
Mailing Address - Phone:732-274-9333
Mailing Address - Fax:
Practice Address - Street 1:4446 RT 27
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:08528
Practice Address - Country:US
Practice Address - Phone:732-274-9333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00330700103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical