Provider Demographics
NPI:1194791426
Name:CRAIG, ROBERT PAUL (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PAUL
Last Name:CRAIG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3226 STATE ROUTE 257
Mailing Address - Street 2:PO BOX 449
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346-2434
Mailing Address - Country:US
Mailing Address - Phone:814-676-2804
Mailing Address - Fax:814-676-0715
Practice Address - Street 1:3226 STATE ROUTE 257
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346-2434
Practice Address - Country:US
Practice Address - Phone:814-676-2804
Practice Address - Fax:814-676-0715
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS 004505-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA531954OtherBLUE SHIELD INDIVIDUAL #
PA275136OtherBLUE SHIELD GROUP NUMBER
PA0014533790005Medicaid
PA021824Medicare PIN
PA531954OtherBLUE SHIELD INDIVIDUAL #