Provider Demographics
NPI:1619969060
Name:KEMMERLING, ROBERT G (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:KEMMERLING
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 1:3270 VALEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-2865
Mailing Address - Country:US
Mailing Address - Phone:805-492-0820
Mailing Address - Fax:
Practice Address - Street 1:60 W OLSEN RD
Practice Address - Street 2:CALIFORNIA LUTHERAN UNIVERSITY, M.S. 4200
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-2700
Practice Address - Country:US
Practice Address - Phone:805-493-3390
Practice Address - Fax:805-493-3388
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11773103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist