Provider Demographics
NPI:1841203668
Name:EVANS, ROBERT MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:EVANS
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 1:3744 MT DIABLO BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549
Mailing Address - Country:US
Mailing Address - Phone:925-284-2303
Mailing Address - Fax:925-284-2303
Practice Address - Street 1:3744 MT DIABLO BLVD
Practice Address - Street 2:STE 103
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549
Practice Address - Country:US
Practice Address - Phone:925-284-2303
Practice Address - Fax:925-284-2303
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9491103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL94910Medicare ID - Type Unspecified
00PL94910Medicare UPIN