Basic Information
| Provider Information | |||||||||
| NPI: | 1194725572 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GINGRICH | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MPSSC COBT CAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 632 CUMBERLAND ST | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170425230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172731710 | ||||||||
| FaxNumber: | 7172731416 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 PEARL ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176033231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173978081 | ||||||||
| FaxNumber: | 7173978414 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.