Provider Demographics
NPI:1821433798
Name:SPAN, ROBIN DENICE (MSW)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:DENICE
Last Name:SPAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 TUOLUMNE ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-4641
Mailing Address - Country:US
Mailing Address - Phone:707-648-8121
Mailing Address - Fax:707-648-8129
Practice Address - Street 1:908 TUOLUMNE ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-4641
Practice Address - Country:US
Practice Address - Phone:707-648-8121
Practice Address - Fax:707-648-8129
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
CA36657104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health