Provider Demographics
NPI:1265261416
Name:DORVIL, ROBENSON (MA)
Entity type:Individual
Prefix:DR
First Name:ROBENSON
Middle Name:
Last Name:DORVIL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:DR
Other - First Name:ROBENSON
Other - Middle Name:
Other - Last Name:DORVIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AMFT
Mailing Address - Street 1:14800 CHADRON AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-3575
Mailing Address - Country:US
Mailing Address - Phone:184-256-0718
Mailing Address - Fax:
Practice Address - Street 1:20695 S WESTERN AVE STE 132
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-1834
Practice Address - Country:US
Practice Address - Phone:424-271-7414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-27
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X, 225400000X
CA225400000X
CAAMFT128092106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner