Basic Information
| Provider Information | |||||||||
| NPI: | 1316063902 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROBERTS | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | DENISE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1032 ARLINGTON WAY | ||||||||
| Address2: | |||||||||
| City: | MARTINEZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945532320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252290588 | ||||||||
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| Practice Location | |||||||||
| Address1: | 202 GLACIER DR | ||||||||
| Address2: | |||||||||
| City: | MARTINEZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945534826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259572755 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC18024 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.