Provider Demographics
NPI:1831682384
Name:FAIR, ROBERT RONALD (LPC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:RONALD
Last Name:FAIR
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1966 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1215
Mailing Address - Country:US
Mailing Address - Phone:215-219-4150
Mailing Address - Fax:
Practice Address - Street 1:1515 W CHESTER PIKE STE C2
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-7782
Practice Address - Country:US
Practice Address - Phone:215-219-4150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-10
Last Update Date:2018-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
PAPC-005435101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist