DR. ROBERT PHIL PARK PSY.D.
NPI 1053472605
Psychologist in Stockton, CA

Active since December 13, 2006PECOS Enrolled
1305 TOMMYDON ST, STOCKTON, CA 95210(209) 476-5211 Get Directions Write a Review

NPPES record last updated: January 3, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Dr. Robert Phil Park Psy.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. ROBERT PHIL PARK PSY.D. (NPI 1053472605) is an individual psychologist in Stockton, California, licensed in California (PSY20153) and active in the NPI registry since December 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1053472605
Entity TypeIndividualMale
Primary Taxonomy103T00000X
Provider Legal NameDR. ROBERT PHIL PARKCredential: PSY.D.
Location Address1305 TOMMYDON STStockton, CA 95210-3364
Mailing Address1305 Tommydon StStockton, CA 95210-3364 · (209) 476-5211
Sole ProprietorNo
Enumeration DateDecember 13, 2006
Last NPPES UpdateJanuary 3, 2022
NPI 1053472605 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License Licensed in CA · PSY20153
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
1305 TOMMYDON ST, Stockton, CA 95210

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare (PECOS)

Dr. Robert Phil Park Psy.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Counselor (Mental Health)
1305 TOMMYDON ST
STOCKTON, CA 95210
Social Worker (Clinical)
1305 TOMMYDON ST
STOCKTON, CA 95210
Psychologist
1305 TOMMYDON ST
STOCKTON, CA 95210
Marriage & Family Therapist
1305 TOMMYDON ST
STOCKTON, CA 95210
Social Worker (Clinical)
1305 TOMMYDON ST
STOCKTON, CA 95210
Psychologist (Clinical)
1305 TOMMYDON ST
STOCKTON, CA 95210
Marriage & Family Therapist
1305 TOMMYDON ST
STOCKTON, CA 95210
Marriage & Family Therapist
1305 TOMMYDON ST
STOCKTON, CA 95210

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Robert Park's NPI number?

The NPI number for Robert Park is 1053472605. It was assigned to this individual provider in the NPPES registry on December 13, 2006.

Where is Robert Park located?

Robert Park practices at 1305 Tommydon St, Stockton, CA 95210. The listed phone number is (209) 476-5211.

What is Robert Park's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Robert Park enrolled in Medicare?

Yes. Robert Park is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Robert Park was last updated on January 3, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.