Healthcare Provider Details

I. General information

NPI: 1386851236
Provider Name (Legal Business Name): ROBERT LAWRENCE SUITER PH.D., PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6117 BROCKTON AVE SUITE 207
RIVERSIDE CA
92506-2232
US

IV. Provider business mailing address

6117 BROCKTON AVE SUITE 207
RIVERSIDE CA
92506-2232
US

V. Phone/Fax

Practice location:
  • Phone: 951-276-0645
  • Fax: 951-276-4769
Mailing address:
  • Phone: 951-276-0645
  • Fax: 951-276-4769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY 9946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: