Basic Information
| Provider Information | |||||||||
| NPI: | 1720237530 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEACHAM | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LICENSED PSYCHOLOGIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1965 LYCOMING CREEK ROAD SUITE 208 | ||||||||
| Address2: | THE CARL E. STOTZ BUILDING | ||||||||
| City: | WILLIAMSPORT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702209228 | ||||||||
| FaxNumber: | 5703267301 | ||||||||
| Practice Location | |||||||||
| Address1: | 1965 LYCOMING CREEK ROAD SUITE 208 | ||||||||
| Address2: | THE CARL E. STOTZ BUILDING | ||||||||
| City: | WILLIAMSPORT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702209228 | ||||||||
| FaxNumber: | 5703267301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2008 | ||||||||
| LastUpdateDate: | 09/23/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PS004070-L | PA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.