Provider Demographics
NPI:1396802963
Name:BANCROFT, ROBERT PAUL (MFT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:PAUL
Last Name:BANCROFT
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-7327
Mailing Address - Country:US
Mailing Address - Phone:707-647-2514
Mailing Address - Fax:
Practice Address - Street 1:5416 HOLDENER
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:CA
Practice Address - Zip Code:95625-0525
Practice Address - Country:US
Practice Address - Phone:707-453-6227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 19909106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist