Provider Demographics
NPI:1396047395
Name:ENGEL, ROBERT KARL (CALIFORNIA MFT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:KARL
Last Name:ENGEL
Suffix:
Gender:M
Credentials:CALIFORNIA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:GRATON
Mailing Address - State:CA
Mailing Address - Zip Code:95444-0388
Mailing Address - Country:US
Mailing Address - Phone:707-486-1512
Mailing Address - Fax:
Practice Address - Street 1:101 MORRIS ST STE 207
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3844
Practice Address - Country:US
Practice Address - Phone:707-861-0441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93164106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist