Provider Demographics
NPI:1114222650
Name:VANDER ZWART, ROBERT TROY (MFT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:TROY
Last Name:VANDER ZWART
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3902
Mailing Address - Country:US
Mailing Address - Phone:858-692-2095
Mailing Address - Fax:
Practice Address - Street 1:3435 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 205
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3902
Practice Address - Country:US
Practice Address - Phone:858-692-2095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49557106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist