Provider Demographics
NPI:1508122128
Name:O'BYRNE, ROBYNNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBYNNE
Middle Name:
Last Name:O'BYRNE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2175 E. FRANCISCO BLVD
Mailing Address - Street 2:SUITE L
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901
Mailing Address - Country:US
Mailing Address - Phone:415-457-1910
Mailing Address - Fax:415-456-9802
Practice Address - Street 1:2175 FRANCISCO BLVD E
Practice Address - Street 2:SUITE L
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-5510
Practice Address - Country:US
Practice Address - Phone:415-457-1910
Practice Address - Fax:415-456-9802
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17737103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical