Provider Demographics
NPI:1265414445
Name:JUSTICE, ROBERT H (PSYD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:JUSTICE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 OREGON PIKE
Mailing Address - Street 2:STE 200
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601
Mailing Address - Country:US
Mailing Address - Phone:717-581-5255
Mailing Address - Fax:717-481-5259
Practice Address - Street 1:1755 OREGON PIKE
Practice Address - Street 2:STE 200
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601
Practice Address - Country:US
Practice Address - Phone:717-581-5255
Practice Address - Fax:717-481-5259
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007009L103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA509767OtherBLUE SHIELD
PA509767OtherBLUE SHIELD
PA509767Medicare ID - Type Unspecified