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General NPI Number Information
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NPI Number | 1962418111
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Entity Type | Individual
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Provider Name | ROBERT JOSEPH LEDERMANN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1094 CUDAHY PL 314
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City | SAN DIEGO
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State | CA
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Zip | 92110-3931
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Country | US
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Telephone | 619-276-8112
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Fax |
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Provider Business Mailing Address
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Address Line | 3249 VIA MARIN
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City | LA JOLLA
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State | CA
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Zip | 92037-2937
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Country | US
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Telephone | 619-944-6438
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS 9831
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License Number State | CA
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