Healthcare Provider Details

I. General information

NPI: 1033366935
Provider Name (Legal Business Name): ROBIN RENEE WALLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UC BERKELEY UNIVERSITY HEALTH 2222 BANCROFT WAY
BERKELEY CA
94720-0001
US

IV. Provider business mailing address

UC BERKELEY UNIVERSITY HEALTH 2222 BANCROFT WAY
BERKELEY CA
94720-0001
US

V. Phone/Fax

Practice location:
  • Phone: 510-642-6074
  • Fax:
Mailing address:
  • Phone: 510-642-6074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS24436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: