Healthcare Provider Details

I. General information

NPI: 1447319181
Provider Name (Legal Business Name): ROBERT HUMPHRIES JR. PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4845 FULTON DR NW STE 4
CANTON OH
44718-2300
US

IV. Provider business mailing address

4845 FULTON DR NW STE 4
CANTON OH
44718-2300
US

V. Phone/Fax

Practice location:
  • Phone: 330-244-8782
  • Fax: 330-244-8795
Mailing address:
  • Phone: 330-244-8782
  • Fax: 330-244-8795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5492
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: