Provider Demographics
NPI:1568685600
Name:DENSMORE, ROBERT WARREN (MA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:WARREN
Last Name:DENSMORE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935 LETITIA AVE
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5021
Mailing Address - Country:US
Mailing Address - Phone:530-626-0266
Mailing Address - Fax:
Practice Address - Street 1:344 PLACERVILLE DR
Practice Address - Street 2:SUITE 17
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-3920
Practice Address - Country:US
Practice Address - Phone:530-621-6290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 51260106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist