Provider Demographics
NPI:1710032941
Name:ECKERT, ROBERT K (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:K
Last Name:ECKERT
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:PO BOX 469
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-0469
Mailing Address - Country:US
Mailing Address - Phone:413-351-5470
Mailing Address - Fax:
Practice Address - Street 1:19 CENTER CT
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3006
Practice Address - Country:US
Practice Address - Phone:413-351-5470
Practice Address - Fax:413-529-1849
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7253103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0500020OtherMBHP-MASS BEH HEAL PARTNE
MA407 252OtherTUFTS NEW ENGLAND
MAW05935OtherBLUE CROSS-BLUE SHIELD
MAVC6000241074OtherMASS REHAB COMMISSION
MA0500020Medicaid
MAW50606Medicare ID - Type UnspecifiedEC W50606