Provider Demographics
NPI:1528194743
Name:DECKER, ROBERT E (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:DECKER
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 1:131 MIRA WAY
Mailing Address - Street 2:
Mailing Address - City:PORTOLA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94028-7465
Mailing Address - Country:US
Mailing Address - Phone:650-321-9292
Mailing Address - Fax:
Practice Address - Street 1:411 KIPLING ST
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-1530
Practice Address - Country:US
Practice Address - Phone:650-321-9292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5433103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical