Provider Demographics
NPI:1225199185
Name:FRAGNER, ROBIN BETH (PHD)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:BETH
Last Name:FRAGNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 JERSEY ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-3710
Mailing Address - Country:US
Mailing Address - Phone:415-647-6292
Mailing Address - Fax:415-647-6292
Practice Address - Street 1:2950 CAMINO DIABLO STE 120
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-3979
Practice Address - Country:US
Practice Address - Phone:925-947-1997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6818103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent