Provider Demographics
NPI:1467651638
Name:INNERFELD, ROBERT DAVID (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DAVID
Last Name:INNERFELD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 180210
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92178-0210
Mailing Address - Country:US
Mailing Address - Phone:619-522-7942
Mailing Address - Fax:619-221-6565
Practice Address - Street 1:KAISER PERMANENTE
Practice Address - Street 2:3420 KENYON STREET
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110
Practice Address - Country:US
Practice Address - Phone:619-221-6129
Practice Address - Fax:619-221-6565
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW 119501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00202464OtherKAISER PERMANENTE