Healthcare Provider Details

I. General information

NPI: 1780052092
Provider Name (Legal Business Name): ROBYN T. DEBARY PSYD., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3694 HILBORN RD STE 150
FAIRFIELD CA
94534-7988
US

IV. Provider business mailing address

2401 WATERMAN BLVD STE A4, PMB 265
FAIRFIELD CA
94534-1800
US

V. Phone/Fax

Practice location:
  • Phone: 808-783-3387
  • Fax:
Mailing address:
  • Phone: 808-783-3387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number27443
License Number StateCA

VIII. Authorized Official

Name: DR. ROBYN TAKESHITA DEBARY
Title or Position: PSYCHOLOGIST
Credential: PSYD
Phone: 808-783-3387