Provider Demographics
NPI:1083873749
Name:DEUCHAR, ROBERT ALLEN
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALLEN
Last Name:DEUCHAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 17TH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1527
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:519 17TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1527
Practice Address - Country:US
Practice Address - Phone:510-628-9065
Practice Address - Fax:510-628-9068
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 390200000X
CAPSY28444103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program