Basic Information
| Provider Information | |||||||||
| NPI: | 1114158300 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLMBERG | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | JEROME | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | M.S. COUNSELING | ||||||||
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| Mailing Information | |||||||||
| Address1: | 37 MORNINGSIDE DR | ||||||||
| Address2: | |||||||||
| City: | SAN ANSELMO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949601431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624586222 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 555 NORTHGATE DR | ||||||||
| Address2: | FAMILY SERVICE AGENCY OF MARIN | ||||||||
| City: | SAN RAFAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949033680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154915700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2009 | ||||||||
| LastUpdateDate: | 08/05/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | IMF59123 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.