Provider Demographics
NPI:1588862460
Name:BABB, ROBERT W (MFT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:W
Last Name:BABB
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24050 MADISON ST
Mailing Address - Street 2:#203A
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6015
Mailing Address - Country:US
Mailing Address - Phone:310-375-1955
Mailing Address - Fax:310-791-0436
Practice Address - Street 1:24050 MADISON ST
Practice Address - Street 2:#203A
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6015
Practice Address - Country:US
Practice Address - Phone:310-375-1955
Practice Address - Fax:310-791-0436
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC21162106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist