Provider Demographics
NPI:1942588108
Name:TAKESHITA DEBARY, ROBYN R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROBYN
Middle Name:R
Last Name:TAKESHITA DEBARY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ROBYN
Other - Middle Name:R
Other - Last Name:TAKESHITA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:2857 GANTON CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-7821
Mailing Address - Country:US
Mailing Address - Phone:808-783-3387
Mailing Address - Fax:
Practice Address - Street 1:101 BODIN CIRCLE TRAVIS AFB
Practice Address - Street 2:60 MDOS/SGOW
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535-1800
Practice Address - Country:US
Practice Address - Phone:707-423-5143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 1264103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist