Basic Information
Provider Information
NPI: 1598933095
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROBERTS
FirstName: HAROLD
MiddleName: DARNELL
NamePrefix: DR.
NameSuffix:  
Credential: PSYD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2737 WEST CECIL AVE
Address2:  
City: DELANO
State: CA
PostalCode: 93215
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 2737 WEST CECIL AVE
Address2:  
City: DELANO
State: CA
PostalCode: 93215
CountryCode: US
TelephoneNumber: 6617212345
FaxNumber: 6617216262
Other Information
ProviderEnumerationDate: 02/19/2008
LastUpdateDate: 02/19/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TR0400X  Y Behavioral Health & Social Service ProvidersPsychologistRehabilitation

No ID Information.


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