Provider Demographics
NPI:1083644835
Name:LARK, ROBERT LAURENCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LAURENCE
Last Name:LARK
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 3074
Mailing Address - Street 2:
Mailing Address - City:RUNNING SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92382-3074
Mailing Address - Country:US
Mailing Address - Phone:562-706-5516
Mailing Address - Fax:909-867-2671
Practice Address - Street 1:8301 FLORENCE AVE
Practice Address - Street 2:STE. 315
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-3936
Practice Address - Country:US
Practice Address - Phone:562-706-5516
Practice Address - Fax:909-867-2671
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 34340106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist