MEDICARE: DR. ROBYN CANNON PEARL PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	25174	CA

General Provider Information

NPI Number	:	1770836603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBYN CANNON PEARL PSYD

Provider Business Mailing Address
First Line	:	PO BOX 322
Second Line	:
City	:	KENTFIELD
State	:	CA
Zip	:	94914
Country	:	US
Telephone Number	:	415-322-0357
Fax Number	:

Provider Business Practice Location Address
First Line	:	1516 OAK ST
Second Line	:	SUITE 313
City	:	ALAMEDA
State	:	CA
Zip	:	94501-2947
Country	:	US
Telephone Number	:	415-322-0357
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2012
Last Update Date	:	08/21/2023

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