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General NPI Number Information
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NPI Number | 1659579217
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Entity Type | Organization
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Legal Business Name | ROBERT COLEGROVE PSYCHOLOGICAL SERVICES INC
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Dates
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Enumeration Date | 07/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15409 DICKENS STREET
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City | SHERMAN OAKS
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State | CA
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Zip | 91403
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Country | US
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Telephone | 818-986-4362
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Fax | 818-986-9263
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Provider Business Mailing Address
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Address Line | 15409 DICKENS STREET
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City | SHERMAN OAKS
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State | CA
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Zip | 91403
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Country | US
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Telephone | 818-986-4362
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Fax | 818-986-9263
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. ROBERT WRIGHT COLEGROVE JR.
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Credential | ED.D.
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Telephone | 818-986-4362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PSY10862
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License Number State | CA
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