Provider Demographics
NPI:1427187160
Name:MATLOCK, ROBYN O (LMFT)
Entity Type:Individual
Prefix:MS
First Name:ROBYN
Middle Name:O
Last Name:MATLOCK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:49 JOY AVE
Mailing Address - Street 2:B
Mailing Address - City:BRISBANE
Mailing Address - State:CA
Mailing Address - Zip Code:94005-1749
Mailing Address - Country:US
Mailing Address - Phone:415-994-2630
Mailing Address - Fax:520-505-1255
Practice Address - Street 1:1475 HUNTINGTON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5990
Practice Address - Country:US
Practice Address - Phone:415-994-2630
Practice Address - Fax:520-505-1255
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37589106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist