Healthcare Provider Details

I. General information

NPI: 1861526808
Provider Name (Legal Business Name): ROBIN LEE WALTER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 E LOS ANGELES AVE
SIMI VALLEY CA
93065-3940
US

IV. Provider business mailing address

545 STONEHEDGE DR
FILLMORE CA
93015-1033
US

V. Phone/Fax

Practice location:
  • Phone: 805-577-0830
  • Fax:
Mailing address:
  • Phone: 805-524-3294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16766
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: