Provider Demographics
NPI:1336317874
Name:COBB, DOUGLASS (MASTER)
Entity Type:Individual
Prefix:MR
First Name:DOUGLASS
Middle Name:
Last Name:COBB
Suffix:
Gender:M
Credentials:MASTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 CARLETON ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-1906
Mailing Address - Country:US
Mailing Address - Phone:510-593-6562
Mailing Address - Fax:
Practice Address - Street 1:1730 CARLETON ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-1906
Practice Address - Country:US
Practice Address - Phone:510-593-6562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist