Provider Demographics
NPI: | 1952483265 |
---|---|
Name: | SKELLY, ROBERT E (PHD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | ROBERT |
Middle Name: | E |
Last Name: | SKELLY |
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 608 |
Mailing Address - Street 2: | |
Mailing Address - City: | LEMONT |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 16851-0608 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 717-263-9093 |
Mailing Address - Fax: | 717-263-2252 |
Practice Address - Street 1: | 43 W WASHINGTON ST |
Practice Address - Street 2: | |
Practice Address - City: | CHAMBERSBURG |
Practice Address - State: | PA |
Practice Address - Zip Code: | 17201-2462 |
Practice Address - Country: | US |
Practice Address - Phone: | 717-263-9093 |
Practice Address - Fax: | 717-263-2252 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-10-19 |
Last Update Date: | 2021-04-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | PS005202L | 103T00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 103T00000X | Behavioral Health & Social Service Providers | Psychologist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
156751 | Other | VALUE OPTIONS | |
PA | 50249 | Other | SOUTH CENTRAL PREFERRED |
PA | SK666502 | Other | BLUE SHIELD |
PA | 50009675 | Other | BLUE CROSS |
306227 | Other | MHN | |
258421 | Other | MAMSI | |
156751 | Other | VALUE OPTIONS |