Provider Demographics
NPI:1467483123
Name:MATANO, ROBERT ANTHONY (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANTHONY
Last Name:MATANO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5665 COLLEGE AVE
Mailing Address - Street 2:SUITE 320B
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1625
Mailing Address - Country:US
Mailing Address - Phone:510-559-9011
Mailing Address - Fax:510-526-9334
Practice Address - Street 1:5665 COLLEGE AVE
Practice Address - Street 2:SUITE 320B
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1625
Practice Address - Country:US
Practice Address - Phone:510-559-9011
Practice Address - Fax:510-526-9334
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9841103TA0400X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical