MEDICARE: DR. ROBERT H KAMMEN PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PS-006066-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PS006066L	OTHER	PA	STATE LICENSE

General Provider Information

NPI Number	:	1063415206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT H KAMMEN PSY.D.

Provider Business Mailing Address
First Line	:	250 PIERCE ST
Second Line	:	STE 214
City	:	KINGSTON
State	:	PA
Zip	:	18704-5149
Country	:	US
Telephone Number	:	570-718-1760
Fax Number	:	570-718-1763

Provider Business Practice Location Address
First Line	:	250 PIERCE ST
Second Line	:	STE 214
City	:	KINGSTON
State	:	PA
Zip	:	18704-5149
Country	:	US
Telephone Number	:	570-718-1760
Fax Number	:	570-718-1763

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/08/2007

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