Provider Demographics
NPI:1417184151
Name:MYERS JR., ROBERT R (LCSW, CCDP DIPLOMATE)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:R
Last Name:MYERS JR.
Suffix:
Gender:M
Credentials:LCSW, CCDP DIPLOMATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:864 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-2516
Mailing Address - Country:US
Mailing Address - Phone:215-301-8613
Mailing Address - Fax:
Practice Address - Street 1:864 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-2516
Practice Address - Country:US
Practice Address - Phone:215-301-8613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-21
Last Update Date:2009-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA400314101YA0400X
PACW0131891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical