Provider Demographics
NPI:1962757351
Name:YEGANEH, ROBIN (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:
Last Name:YEGANEH
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 1:548 MARKET ST, PMB 99338
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-5401
Mailing Address - Country:US
Mailing Address - Phone:925-400-9604
Mailing Address - Fax:
Practice Address - Street 1:111 DEERWOOD RD
Practice Address - Street 2:SUITE 395
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4409
Practice Address - Country:US
Practice Address - Phone:925-984-8337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21202103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral