Provider Demographics
NPI:1588796288
Name:ROBERTSON, JAY ARDEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:ARDEN
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:ARDEN
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1559
Mailing Address - Country:US
Mailing Address - Phone:661-635-3050
Mailing Address - Fax:661-869-1503
Practice Address - Street 1:3717 MT PINES WAY
Practice Address - Street 2:SUITE C AND D
Practice Address - City:FRAZIER PARK
Practice Address - State:CA
Practice Address - Zip Code:93225
Practice Address - Country:US
Practice Address - Phone:661-245-0250
Practice Address - Fax:661-245-0252
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40292106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist