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General NPI Number Information
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NPI Number | 1710085105
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Entity Type | Individual
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Provider Name | ROBERT R IDDINGS PH. D.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/13/2012
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Provider Practice Location Address
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Address Line | 1363 W 6TH ST
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City | ERIE
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State | PA
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Zip | 16505-2559
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Country | US
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Telephone | 814-490-4740
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Fax | 814-455-0754
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Provider Business Mailing Address
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Address Line | 529 VERMONT AVE
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City | ERIE
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State | PA
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Zip | 16505-2337
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Country | US
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Telephone | 814-490-4740
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Fax | 814-455-0754
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LP004193
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS016657L
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS016657L
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License Number State | PA
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