Healthcare Provider Details

I. General information

NPI: 1063565745
Provider Name (Legal Business Name): PSYCHOTHERAPY INSTITUTE OF INDIVIDUAL, FAMILY & COMMUNITY DEVELOPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 W 10TH ST
ANTIOCH CA
94509-1653
US

IV. Provider business mailing address

509 W 10TH ST
ANTIOCH CA
94509-1653
US

V. Phone/Fax

Practice location:
  • Phone: 925-777-9540
  • Fax: 925-757-9024
Mailing address:
  • Phone: 925-777-9540
  • Fax: 925-757-9024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY15066
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY15066
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY15066
License Number StateCA

VIII. Authorized Official

Name: DR. WESLEY A ROBINSON
Title or Position: VICE PRESIDENT
Credential: PH.D.
Phone: 925-777-9540