Provider Demographics
NPI:1063415206
Name:KAMMEN, ROBERT H (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
Last Name:KAMMEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 PIERCE ST
Mailing Address - Street 2:STE 214
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5149
Mailing Address - Country:US
Mailing Address - Phone:570-718-1760
Mailing Address - Fax:570-718-1763
Practice Address - Street 1:250 PIERCE ST
Practice Address - Street 2:STE 214
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5149
Practice Address - Country:US
Practice Address - Phone:570-718-1760
Practice Address - Fax:570-718-1763
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-006066-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPS006066LOtherSTATE LICENSE
PAPS006066LOtherSTATE LICENSE
PAKA672483Medicare ID - Type Unspecified