Individual
DR. ROBERT R IDDINGS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH. D.
Contact information
Practice address
1363 W 6TH ST, ERIE, PA 16505-2559
(814) 490-4740
(814) 455-0754
Mailing address
529 VERMONT AVE, ERIE, PA 16505-2337
(814) 490-4740
(814) 455-0754
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
LP004193
PA
103T00000X
Psychologist
Primary
PS016657L
PA
103TC0700X
Clinical Psychologist
PS016657L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PC004193
PROFESSIONAL COUN LICENSE
PA
01
—
PS016657L
LICENSED PSYCHOLOGIST
PA
Enumeration date
09/20/2006
Last updated
08/13/2012
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