Provider Demographics
NPI:1770951667
Name:HEASLEY, ROBERT (PHD LMFT)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:HEASLEY
Suffix:
Gender:M
Credentials:PHD LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 PARK AVE STE 2B
Mailing Address - Street 2:
Mailing Address - City:SWARTHMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19081-1736
Mailing Address - Country:US
Mailing Address - Phone:484-362-9453
Mailing Address - Fax:
Practice Address - Street 1:110 PARK AVE STE 2B
Practice Address - Street 2:
Practice Address - City:SWARTHMORE
Practice Address - State:PA
Practice Address - Zip Code:19081-1736
Practice Address - Country:US
Practice Address - Phone:484-362-9453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000819106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAA6OtherPYSCHO-THERAPIST