Provider Demographics
NPI:1447319181
Name:HUMPHRIES, ROBERT JR (PHD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:HUMPHRIES
Suffix:JR
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 1:1201 SOUTH MAIN ST.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720
Mailing Address - Country:US
Mailing Address - Phone:330-244-8782
Mailing Address - Fax:330-244-8795
Practice Address - Street 1:1201 S MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-4283
Practice Address - Country:US
Practice Address - Phone:330-244-8782
Practice Address - Fax:330-244-8795
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2010-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5492103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH083656000OtherMAGELLAN
OH191242OtherMHN
OH341302914034OtherCARESOURCE
OH2106563Medicaid
OH000000130016OtherANTHEM
OH341302914034OtherCARESOURCE