Provider Demographics
NPI:1306336888
Name:ROBERTSON, DEBRA ANN (PHD)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:ANN
Other - Last Name:LANHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1341 SPRINGBROOK RD
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-3918
Mailing Address - Country:US
Mailing Address - Phone:415-819-8517
Mailing Address - Fax:
Practice Address - Street 1:1 MAIN ST
Practice Address - Street 2:
Practice Address - City:SAN QUENTIN
Practice Address - State:CA
Practice Address - Zip Code:94964-1000
Practice Address - Country:US
Practice Address - Phone:415-454-1460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30593103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical