Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 0810005840 | VA |
Y | 103T00000X | Psychologist | 0810005840 | VA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 0810005840 | VA |
NPI | 1053827451 |
---|---|
Provider Name | Dr. Richard Roberson III |
First Address | San Antonio, TX 78229-3893 |
Second Address | San Antonio, TX 78240-3900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2017 |
Last Update Date | 20/12/2017 |