Provider Demographics
NPI:1679500052
Name:HARDMAN, ROBERT E (MFT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:E
Last Name:HARDMAN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 CALARIVA DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-1407
Mailing Address - Country:US
Mailing Address - Phone:209-603-5766
Mailing Address - Fax:209-465-4165
Practice Address - Street 1:2307 W ALPINE AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-2701
Practice Address - Country:US
Practice Address - Phone:209-942-3369
Practice Address - Fax:209-465-4165
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC2360106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist