Healthcare Provider Details

I. General information

NPI: 1598508558
Provider Name (Legal Business Name): ROBERT HAZARD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 HIGH ST
PHOENIXVILLE PA
19460-1336
US

IV. Provider business mailing address

524 MERCER RD
MERION STATION PA
19066-1016
US

V. Phone/Fax

Practice location:
  • Phone: 814-308-0704
  • Fax: 814-308-0704
Mailing address:
  • Phone: 610-955-4274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC002708
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: