Provider Demographics
NPI:1710085105
Name:IDDINGS, ROBERT R (PH D)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:R
Last Name:IDDINGS
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-2337
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PALP004193101YP2500X
PAPS016657L103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC004193OtherPROFESSIONAL COUN LICENSE
PAPS016657LOtherLICENSED PSYCHOLOGIST