Provider Demographics
NPI:1013139765
Name:GARVIN, ROYCE B (PHD)
Entity type:Individual
Prefix:DR
First Name:ROYCE
Middle Name:B
Last Name:GARVIN
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 1:3713 RED OAK WAY
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-1132
Mailing Address - Country:US
Mailing Address - Phone:650-366-4978
Mailing Address - Fax:
Practice Address - Street 1:1690 WOODSIDE RD STE 211
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3402
Practice Address - Country:US
Practice Address - Phone:650-368-0210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 9077103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist