Provider Demographics
NPI:1922467810
Name:MARRIOTT, ROBERT J PAUL (RADT I)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J PAUL
Last Name:MARRIOTT
Suffix:
Gender:M
Credentials:RADT I
Other - Prefix:
Other - First Name:BOB
Other - Middle Name:
Other - Last Name:MARRIOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RADT I
Mailing Address - Street 1:2731 W OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93728-2449
Mailing Address - Country:US
Mailing Address - Phone:559-233-5096
Mailing Address - Fax:559-233-5099
Practice Address - Street 1:2731 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-2449
Practice Address - Country:US
Practice Address - Phone:559-233-5096
Practice Address - Fax:559-233-5099
Is Sole Proprietor?:No
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1193780315101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)