Provider Demographics
NPI:1699793869
Name:WASKA, ROBERT (MFT, PHD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:WASKA
Suffix:
Gender:M
Credentials:MFT, PHD
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 2769
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94979-2769
Mailing Address - Country:US
Mailing Address - Phone:415-883-4235
Mailing Address - Fax:415-472-3634
Practice Address - Street 1:3329 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1911
Practice Address - Country:US
Practice Address - Phone:415-883-4235
Practice Address - Fax:415-472-3634
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 28161101YM0800X
CAMFT28161106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist