Provider Demographics
NPI:1144307620
Name:MARCOVITZ, ROBERT J (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:MARCOVITZ
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 1:210 CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2401
Mailing Address - Country:US
Mailing Address - Phone:215-646-5349
Mailing Address - Fax:
Practice Address - Street 1:1012 BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:SPRING HOUSE
Practice Address - State:PA
Practice Address - Zip Code:19477-0086
Practice Address - Country:US
Practice Address - Phone:215-646-5349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002875L103T00000X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
PW142602OtherBLUE CROSS/ BLUE SHIELD
PA0004088155OtherAETNA
PAR06286Medicare UPIN
PA142602Medicare ID - Type UnspecifiedMEDICARE ID