Healthcare Provider Details

I. General information

NPI: 1225199185
Provider Name (Legal Business Name): ROBIN BETH FRAGNER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 CAMINO DIABLO STE 120
WALNUT CREEK CA
94597-3979
US

IV. Provider business mailing address

314 JERSEY ST
SAN FRANCISCO CA
94114-3710
US

V. Phone/Fax

Practice location:
  • Phone: 925-947-1997
  • Fax:
Mailing address:
  • Phone: 415-647-6292
  • Fax: 415-647-6292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY6818
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: