Provider Demographics
NPI:1891238010
Name:BOBROW, SCOTT MICHAEL
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:MICHAEL
Last Name:BOBROW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:MICHAEL
Other - Last Name:BOBROW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:5354 CLAYTON RD
Mailing Address - Street 2:SUITE B1
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-3257
Mailing Address - Country:US
Mailing Address - Phone:925-381-3429
Mailing Address - Fax:
Practice Address - Street 1:5354 CLAYTON RD
Practice Address - Street 2:SUITE B1
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-3257
Practice Address - Country:US
Practice Address - Phone:925-381-3429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-19
Last Update Date:2016-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86952106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist