Provider Demographics
NPI:1902833353
Name:ROKOP, KRISTIN WATTERSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:WATTERSON
Last Name:ROKOP
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 SCHMEISER AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-4429
Mailing Address - Country:US
Mailing Address - Phone:530-304-0273
Mailing Address - Fax:916-482-0635
Practice Address - Street 1:132 E ST
Practice Address - Street 2:SUITE 320
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4649
Practice Address - Country:US
Practice Address - Phone:530-304-0273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21860103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical