Provider Demographics
NPI:1184817488
Name:MCVAUGH, ROBERT BERRY (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:BERRY
Last Name:MCVAUGH
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6006 BROKEN ARROW COURT
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95621
Mailing Address - Country:US
Mailing Address - Phone:916-847-4768
Mailing Address - Fax:916-722-9229
Practice Address - Street 1:6006 BROKEN ARROW COURT
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621
Practice Address - Country:US
Practice Address - Phone:916-847-4768
Practice Address - Fax:916-722-9229
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39257106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist