Provider Demographics
NPI:1831150192
Name:MORGAN, ROBERT LEROY (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEROY
Last Name:MORGAN
Suffix:
Gender:M
Credentials: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 577185
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-7185
Mailing Address - Country:US
Mailing Address - Phone:209-572-3464
Mailing Address - Fax:
Practice Address - Street 1:2030 COFFEE RD STE C1
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2413
Practice Address - Country:US
Practice Address - Phone:209-572-3464
Practice Address - Fax:209-572-1674
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 6097103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL60970Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER