Healthcare Provider Details

I. General information

NPI: 1013974211
Provider Name (Legal Business Name): DAVID C ROBERTS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4283 PIEDMONT AVE SUITE B
OAKLAND CA
94611-4758
US

IV. Provider business mailing address

4283 PIEDMONT AVE SUITE B
OAKLAND CA
94611-4758
US

V. Phone/Fax

Practice location:
  • Phone: 510-655-1966
  • Fax: 510-595-4340
Mailing address:
  • Phone: 510-655-1966
  • Fax: 510-595-4340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY5645
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: