Provider Demographics
NPI:1386851236
Name:SUITER, ROBERT LAWRENCE (PHD, PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LAWRENCE
Last Name:SUITER
Suffix:
Gender:M
Credentials:PHD, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6117 BROCKTON AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2232
Mailing Address - Country:US
Mailing Address - Phone:951-276-0645
Mailing Address - Fax:951-276-4769
Practice Address - Street 1:6117 BROCKTON AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2232
Practice Address - Country:US
Practice Address - Phone:951-276-0645
Practice Address - Fax:951-276-4769
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 9946103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic