Provider Demographics
NPI:1457612996
Name:SZOPA, ROBERT WALTER (CAADAC RS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WALTER
Last Name:SZOPA
Suffix:
Gender:M
Credentials:CAADAC RS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 S. B ST
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401
Mailing Address - Country:US
Mailing Address - Phone:650-579-7157
Mailing Address - Fax:650-579-5530
Practice Address - Street 1:704 MILL ST
Practice Address - Street 2:
Practice Address - City:LOYALTON
Practice Address - State:CA
Practice Address - Zip Code:96118
Practice Address - Country:US
Practice Address - Phone:530-993-6746
Practice Address - Fax:530-993-6759
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)