Provider Demographics
NPI:1528180585
Name:WYER, ROBB (RAS)
Entity Type:Individual
Prefix:MR
First Name:ROBB
Middle Name:
Last Name:WYER
Suffix:
Gender:M
Credentials:RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3932 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93702-2247
Mailing Address - Country:US
Mailing Address - Phone:559-600-4877
Mailing Address - Fax:
Practice Address - Street 1:3333 E AMERICAN AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93725-9235
Practice Address - Country:US
Practice Address - Phone:559-600-4877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARASW0702101336101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARASW0702101336OtherREGISTERED ADDICTION SPECIALIST