Healthcare Provider Details

I. General information

NPI: 1417926197
Provider Name (Legal Business Name): ROBERT PETER PETRUZZI PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1489 BALTIMORE PIKE BLDG. 200, SUITE 250
SPRINGFIELD PA
19064-3958
US

IV. Provider business mailing address

1489 BALTIMORE PIKE BLDG. 200, SUITE 250
SPRINGFIELD PA
19064-3958
US

V. Phone/Fax

Practice location:
  • Phone: 610-544-2110
  • Fax: 610-604-9510
Mailing address:
  • Phone: 610-544-2110
  • Fax: 610-604-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPS003470-L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS003470-L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPS003470-L
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPS003470-L
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS003470-L
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPS003470-L
License Number StatePA
# 7
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberPS003470-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: