Healthcare Provider Details

I. General information

NPI: 1205958865
Provider Name (Legal Business Name): ROBERT KARL KRETZ PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15409 DICKENS ST
SHERMAN OAKS CA
91403-3009
US

IV. Provider business mailing address

15409 DICKENS ST
SHERMAN OAKS CA
91403-3009
US

V. Phone/Fax

Practice location:
  • Phone: 818-986-4362
  • Fax: 818-986-4362
Mailing address:
  • Phone: 818-986-4362
  • Fax: 818-986-4362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number18198
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number18198
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: