Provider Demographics
NPI:1215343710
Name:LIM, ROBERT
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39812 MISSION BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-3087
Mailing Address - Country:US
Mailing Address - Phone:510-804-5565
Mailing Address - Fax:855-975-0618
Practice Address - Street 1:39812 MISSION BLVD STE 106
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-3087
Practice Address - Country:US
Practice Address - Phone:510-804-5565
Practice Address - Fax:855-975-0618
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist