Provider Demographics
NPI:1659579217
Name:ROBERT COLEGROVE PSYCHOLOGICAL SERVICES INC
Entity Type:Organization
Organization Name:ROBERT COLEGROVE PSYCHOLOGICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WRIGHT
Authorized Official - Last Name:COLEGROVE
Authorized Official - Suffix:JR
Authorized Official - Credentials:EDD
Authorized Official - Phone:818-986-4362
Mailing Address - Street 1:15409 DICKENS STREET
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403
Mailing Address - Country:US
Mailing Address - Phone:818-986-4362
Mailing Address - Fax:818-986-9263
Practice Address - Street 1:15409 DICKENS STREET
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403
Practice Address - Country:US
Practice Address - Phone:818-986-4362
Practice Address - Fax:818-986-9263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10862103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty