Provider Demographics
NPI:1285148155
Name:SEMISCH, ROBERT GAR JR
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:GAR
Last Name:SEMISCH
Suffix:JR
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 1:6145 OAKGREEN CIR
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-1010
Mailing Address - Country:US
Mailing Address - Phone:619-552-1177
Mailing Address - Fax:
Practice Address - Street 1:6145 OAKGREEN CIR
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-1010
Practice Address - Country:US
Practice Address - Phone:619-552-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)