Healthcare Provider Details

I. General information

NPI: 1417154394
Provider Name (Legal Business Name): SCOTT JEFFREY ROBERTS PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 IRONWOOD WAY
CONCORD CA
94521-4710
US

IV. Provider business mailing address

1160 IRONWOOD WAY
CONCORD CA
94521-4710
US

V. Phone/Fax

Practice location:
  • Phone: 925-457-8950
  • Fax:
Mailing address:
  • Phone: 925-345-7895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number24419
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number24419
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number24419
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number24419
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: