Provider Demographics
NPI:1669592176
Name:PATRICK, ROBERT HAROLD
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:HAROLD
Last Name:PATRICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9990 COUNTY FARM RD
Mailing Address - Street 2:STE. 6
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3542
Mailing Address - Country:US
Mailing Address - Phone:951-358-6919
Mailing Address - Fax:951-358-7312
Practice Address - Street 1:9990 COUNTY FARM RD
Practice Address - Street 2:STE 6
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3542
Practice Address - Country:US
Practice Address - Phone:951-358-6919
Practice Address - Fax:951-358-7312
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health