Provider Demographics
NPI:1871516328
Name:LUNDQUIST, ROBERT ROLF (MS, PYSD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ROLF
Last Name:LUNDQUIST
Suffix:
Gender:M
Credentials:MS, PYSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 WATER ST
Mailing Address - Street 2:STE 2-C
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4124
Mailing Address - Country:US
Mailing Address - Phone:831-460-0525
Mailing Address - Fax:831-460-0525
Practice Address - Street 1:550 WATER ST
Practice Address - Street 2:STE 2-C
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4124
Practice Address - Country:US
Practice Address - Phone:831-460-0525
Practice Address - Fax:831-460-0525
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT32099101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health