Provider Demographics
NPI:1215190095
Name:TERRIS, ROBERT DUVAL (JD, MFT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DUVAL
Last Name:TERRIS
Suffix:
Gender:M
Credentials:JD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 KING ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-2129
Mailing Address - Country:US
Mailing Address - Phone:510-684-2172
Mailing Address - Fax:
Practice Address - Street 1:2832 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2114
Practice Address - Country:US
Practice Address - Phone:510-684-2172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51095106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist