Provider Demographics
NPI:1780052092
Name:ROBYN T. DEBARY PSYD., INC.
Entity type:Organization
Organization Name:ROBYN T. DEBARY PSYD., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAKESHITA DEBARY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-783-3387
Mailing Address - Street 1:2401 WATERMAN BLVD
Mailing Address - Street 2:STE A4, PMB 265
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1800
Mailing Address - Country:US
Mailing Address - Phone:808-783-3387
Mailing Address - Fax:
Practice Address - Street 1:3694 HILBORN RD
Practice Address - Street 2:STE 150
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-7988
Practice Address - Country:US
Practice Address - Phone:808-783-3387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27443103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty