Healthcare Provider Details

I. General information

NPI: 1659447415
Provider Name (Legal Business Name): ROBERT WASHEK MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3035 RUSTIC LN
ERIE PA
16506-1633
US

IV. Provider business mailing address

3035 RUSTIC LN
ERIE PA
16506-1633
US

V. Phone/Fax

Practice location:
  • Phone: 814-459-2755
  • Fax:
Mailing address:
  • Phone: 814-459-2755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS005448L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: