Healthcare Provider Details

I. General information

NPI: 1568685600
Provider Name (Legal Business Name): ROBERT WARREN DENSMORE M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 PLACERVILLE DR SUITE 17
PLACERVILLE CA
95667-3920
US

IV. Provider business mailing address

2935 LETITIA AVE
PLACERVILLE CA
95667-5021
US

V. Phone/Fax

Practice location:
  • Phone: 530-621-6290
  • Fax:
Mailing address:
  • Phone: 530-626-0266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF 51260
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: