Healthcare Provider Details

I. General information

NPI: 1083873749
Provider Name (Legal Business Name): ROBERT ALLEN DEUCHAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 17TH ST SUITE 210
OAKLAND CA
94612-1527
US

IV. Provider business mailing address

519 17TH ST SUITE 210
OAKLAND CA
94612-1527
US

V. Phone/Fax

Practice location:
  • Phone: 510-628-9065
  • Fax: 510-628-9068
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY28444
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: