Provider Demographics
NPI:1891843355
Name:MORGAN, ROBIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:
Last Name:MORGAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:WENNERBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1201 AVENUE B
Mailing Address - Street 2:APT 1012
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-2300
Mailing Address - Country:US
Mailing Address - Phone:323-481-3389
Mailing Address - Fax:
Practice Address - Street 1:1201 AVENUE B
Practice Address - Street 2:APT 1012
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-2300
Practice Address - Country:US
Practice Address - Phone:323-481-3389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4368103TC0700X
TX36602103TF0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic