Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PSY23699 | CA |
N | 103T00000X | Psychologist | PSY23699 | CA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY23699 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY23699 | CA |
Y | 103TC1900X | Counseling Psychologist | PSY23699 | CA |
NPI | 1003026303 |
---|---|
Provider Name | Robert Mitchell |
First Address | Belmont, CA 94002-3507 |
Second Address | Belmont, CA 94002-3507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 12/12/2013 |