Provider Demographics
NPI:1942588108
Name:TAKESHITA DEBARY, ROBYN R (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROBYN
Middle Name:R
Last Name:TAKESHITA DEBARY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ROBYN
Other - Middle Name:R
Other - Last Name:TAKESHITA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:9241 OLD STATE HWY UNIT 483
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:CA
Mailing Address - Zip Code:95658-1420
Mailing Address - Country:US
Mailing Address - Phone:707-639-0256
Mailing Address - Fax:
Practice Address - Street 1:2401 WATERMAN BLVD STE A4
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-1869
Practice Address - Country:US
Practice Address - Phone:707-639-0256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 1264103T00000X
CA27443103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist