Provider Demographics
NPI:1629129176
Name:ROBINSON, WESLEY ALAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:ALAN
Last Name:ROBINSON
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 1:509 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-1653
Mailing Address - Country:US
Mailing Address - Phone:925-777-9540
Mailing Address - Fax:925-757-9024
Practice Address - Street 1:509 W 10TH ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-1653
Practice Address - Country:US
Practice Address - Phone:925-777-9540
Practice Address - Fax:925-757-9024
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15066103T00000X, 103TC2200X, 103TF0000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL150660Medicare ID - Type Unspecified