Provider Demographics
NPI:1801635784
Name:GERVASI, ROBERT III (MS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:GERVASI
Suffix:III
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:491 ALLENDALE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1472
Mailing Address - Country:US
Mailing Address - Phone:610-265-3400
Mailing Address - Fax:610-200-5780
Practice Address - Street 1:491 ALLENDALE RD STE 201
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1472
Practice Address - Country:US
Practice Address - Phone:610-265-3400
Practice Address - Fax:610-200-5780
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty