Provider Demographics
NPI:1215188735
Name:GOLDBERG, ROBIN (PHD, PSYD,RP)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:PHD, PSYD,RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19732 MACARTHUR BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2419
Mailing Address - Country:US
Mailing Address - Phone:714-573-9044
Mailing Address - Fax:949-725-9436
Practice Address - Street 1:19732 MACARTHUR BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2419
Practice Address - Country:US
Practice Address - Phone:714-573-9044
Practice Address - Fax:949-725-9436
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARP 82102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARP 82OtherRESEARCH PSYCHOANALYST