Provider Demographics
NPI:1699869222
Name:BOSCARELLI, ROBIN THOMAS (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:THOMAS
Last Name:BOSCARELLI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ROBIN
Other - Middle Name:CAROL
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:533 NORTH PECK ROAD
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-1847
Mailing Address - Country:US
Mailing Address - Phone:805-933-3190
Mailing Address - Fax:
Practice Address - Street 1:929 MAIN STREET
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001
Practice Address - Country:US
Practice Address - Phone:805-766-7741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA PSY 14464103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical