Provider Demographics
NPI:1700446697
Name:STOLOROW, ROBERT D (PHD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:D
Last Name:STOLOROW
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 1:744 21ST PLACE
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90402-3052
Mailing Address - Country:US
Mailing Address - Phone:310-393-0604
Mailing Address - Fax:
Practice Address - Street 1:744 21ST PLACE
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90402-3052
Practice Address - Country:US
Practice Address - Phone:310-393-0604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7830103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis