MEDICARE: DR. ROBERT E BECKER PH.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	103TC0700X	Clinical Psychologist	PS004565L	PA

General Provider Information

NPI Number	:	1588661433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT E BECKER PH.D.

Provider Business Mailing Address
First Line	:	512 MELISSA DR
Second Line	:
City	:	AMBLER
State	:	PA
Zip	:	19002-5046
Country	:	US
Telephone Number	:	215-628-8072
Fax Number	:	215-628-8072

Provider Business Practice Location Address
First Line	:	512 MELISSA DR
Second Line	:
City	:	AMBLER
State	:	PA
Zip	:	19002-5046
Country	:	US
Telephone Number	:	215-628-8072
Fax Number	:	215-628-8072

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/06/2010

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