Provider Demographics
NPI:1396967766
Name:HASTINGS, C. ROGER (PHD)
Entity type:Individual
Prefix:DR
First Name:C.
Middle Name:ROGER
Last Name:HASTINGS
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 1:827 DEEP VALLEY DR STE 203
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3668
Mailing Address - Country:US
Mailing Address - Phone:310-995-0054
Mailing Address - Fax:310-377-0056
Practice Address - Street 1:827 DEEP VALLEY DR STE 203
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3668
Practice Address - Country:US
Practice Address - Phone:310-995-0054
Practice Address - Fax:310-377-0056
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10334103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY10334OtherPSYCHOLOGY LICENSE NUMBER