Provider Demographics
NPI:1184762981
Name:CONNERLEY, ROBERT C (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:CONNERLEY
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 1:7177 BROCKTON AVE STE 331
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2634
Mailing Address - Country:US
Mailing Address - Phone:951-788-8810
Mailing Address - Fax:951-788-8811
Practice Address - Street 1:7177 BROCKTON AVE STE 331
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2634
Practice Address - Country:US
Practice Address - Phone:951-788-8810
Practice Address - Fax:951-788-8811
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21844103TC0700X
CAMFC38478106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist